5 LIBRARY OF CONGRESS, i 

l! UNITED STATES OF AMERICA. 



ASIATIC CHOLERA 

A TREATISE 



ON ITS 



ORIGIN, PATHOLOGY, TREATMENT, 
AND CURE. 



BY 

E. WHITNEY, M. D., 

AND 

A. B. WHITNEY, A. M., M. D., 

* LATE PHYSICIAN AND SURGEON 

To Diseases of Women in the North- Western Dispensary, Visiting Physician, Etc. 



New York: 

JVL W. DODD, PUBLISHER, 

No. 506 Broadway. 

1866. 



Entered according to Act of Congress, in the year 1866, by 

A. B. WHITNEY, A. M., M. D., 

In the Clerk's Office of the District Court of the United States, 
for the Southern District of New York. 



JENKINS, 3TERE0TYPER AND PRINTER, 
20 NORTH WILUAM ST., N. Y. 



DEDICATION. 



TO PROFESSOES POST, YAN BUEEN, METCALF, 
AND BEPFOBD. 



For those lucid Clinic illustrations and faithful instruc- 
tions during a three-years' course in the New York Medical 
University, particularly the critical Pathological knowledge 
there inculcated, and consequent professional success, the 
youthful author is indebted. 

Knowing they will agree with him, that his appreciation 
of their valued services, and his gratitude for the same, 
can be best acknowledged in his attempt to benefit suffer- 
ing humanity, he would here publicly acknowledge the 
pleasure and benefit received from their instructions 
during his College course, and beg their acceptance of his 
sincerest gratitude and affection. 

to these able instructors this volume is cordially 
Dedicated by the Junior Author. 

A. B. WHITNEY, M. D. 



PREFACE. 



The following pages are the result of investiga- 
tions and the collection of facts and arguments from 
a great variety of sources, originally made and 
presented in aid of the discussions on the subject 
during the past six or eight months. 

The most eminent and reliable authorities for 
nearly half a century, that is, from 1832 to 1865, 
including the late reports from India, have been 
carefully examined, and such late discoveries, facts, 
and arguments collected, as seemed to throw light 
upon the subject, or in any degree to indicate or 
direct to a general principle of practice. 

The various experiments instituted for the cure 
of the disease have been carefully investigated, and 
the principle evolved explained whenever any ad- 
vantage was derived from the same. 

In all these we have diligently searched for the 
cause of the failure of " remedial agents," so uni- 
formly admitted, and have endeavored to present 
the results clearly and fully in the body of the 
work. 

Our statistics are collected from reliable sources, 

(5) 



PREFACE. 



The following pages are the result of investiga- 
tions and the collection of facts and arguments from 
a great variety of sources, originally made and 
presented in aid of the discussions on the subject 
during the past six or eight months. 

The most eminent and reliable authorities for 
nearly half a century, that is, from 1832 to 1865, 
including the late reports from India, have been 
carefully examined, and such late discoveries, facts, 
and arguments collected, as seemed to throw light 
upon the subject, or in any degree to indicate or 
direct to a general principle of practice. 

The various experiments instituted for the cure 
of the disease have been carefully investigated, and 
the principle evolved explained whenever any ad- 
vantage was derived from the same. 

In all these we have diligently searched for the 
cause of the failure of " remedial agents," so uni- 
formly admitted, and have endeavored to present 
the results clearly and fully in the body of the 
work. 

Our statistics are collected from reliable sources, 

(5) 



G PREFACE. 

are very brief, and introduced in aid of the main 
object, — the establishment of a general principle 
of practice. 

The different modes of practice are from the 
most distinguished authors of the different Schools 
of Medicine, and non-professional gentlemen ; con_ 
clensed and exhibited mainly in their own language, 
to show their conformity or non-conformity to the 
Pathology of the disease. 

In all we have kept constantly in view the 
pathology of the disease, whose " dictates " have 
governed us in the exhibition and establishment 
of a general principle of rational practice, con- 
firmed by observation and experience, which, if 
accepted and carried out by the profession, we 
hope and trust will save a very large proportion of 
those attacked by "this most acute of acute dis- 
eases." 

AUTHORS. 



CONTENTS. 



CHAPTER I. 

Sec. I. Origin and Development 7 

Sec. II. Progress and Fatality 20 

Sec. III. Causes— Propagation 34 

CHAPTER II. 

Sec. I. Pathology , 45 

Sec. II. Phenomena, or Symptoms 55 

CHAPTER III. 

Sec. I. Unsuccessful Modes of Treatment. — 

Venous Transfusion Explained 64 

Sec. II. Physiological Condition of the Blood, 
Its Non- Aeration, or Non-Oxydation. 
Maxims of Rational Practice Sug- 
gested. 91 

Sec. III. Different Modes of Treatment 130 

Sec. IV. Statistics. Percentage of Loss. Vari- 
able Results— their Cause 166 

(7) 



6 CONTENTS. 

CHAPTER IV. 
Sec. I. General Principle of Rational Prac- 
tice, Dictated by the Pathology op 
the Disease, Confirmed by Observa- 
tion and Experience , 178 

Sec. II. Remedies, Recipes, Etc 188 

Sec. III. Prophylaxis, or Means of Prevention.. 203 
Sec. IV. Formula — Preparations, Etc 213 



ASIATIC CHOLERA. 



CHAPTER I. 

Section I. — Origin and Development. 

Epidemics have occasionally prevailed in 
all ages. Sometimes they have been cir- 
cumscribed in their influence, and limited 
to particular localities ; while at other 
periods they have taken a wider range and 
extended over larger sections, inflicting the 
most lamentable results, and augmenting 
the bills of mortality to an incredible de- 
gree. 

The earlier writers have given some ac- 
count of these diseases, which have occa- 
sionally prevailed as very fatal and devas- 
tating epidemics ; surpassing all other dis- 
eases in their mysterious origin, in their 



© ASIATIC CHOLERA. 

rapid extension, and in the duration of their 
prevalence. In the East, — in Egypt, and 
on the eastern border of the Mediterranean, 
fearful epidemics have prevailed from time 
immemorial. They have often proved very 
destructive, especially in the Middle Ages, 
and as late as the sixteenth and seventeenth 
centuries. During the prevalence of the 
" Pestis," which raged throughout Europe 
between the years 1347 and 1350, accord- 
ing to computation, a fourth part of the 
inhabitants of this part of the globe was 
carried off. The estimates of the vast 
numbers swept away by its repeated occur- 
rence and prevalence appear quite incred- 
ible. 

During the time it raged at Marseilles in 
1720, it is reported that in the Charity 
Hospital there were admitted from October 
3d to February 28th, 1,013 patients, of 
whom 585 died ; and during the same 
period, in another hospital, there were ad- 
mitted from October to July 3d, 1,512 pa- 
tients, of whom 820 died. The population 
of Marseilles previous to the occurrence 



ORIGIN AND DEVELOPMENT. 9 

of the disease was estimated at* about 
90,000, of whom 40,000 died ; leaving only 
about 10,000 of the whole population who 
had not been attacked or in any way affect- 
ed ; so that the record shows the appalling 
mortality of fifty per cent, of those who 
were attacked. 

The bills of mortality in 1770 and 1771 
were as appalling as any arising from epi- 
demics of a later day. A very extended 
notice of the " Pestis " as it raged in Mos- 
cow in the year 1771 is given by M. 
Gerardin, who, quoting from the published 
statistics, observes : " In April, the deaths 
were 744 ; May, 851 ; June, 1,099 ; July, 
1,708 ; August, 7,268 ; September, 21,401 ; 
October, 17,561 ; November, 5,235 ; De- 
cember, 805 ; making a total in nine months 
of 56,672, which is considerably less than 
the estimate given by De Mertens, who 
thinks the whole number carried off by this 
pestilence, from the city alone, cannot be 
less than 80,000. These statistics bear a 
striking resemblance to those of the Epi- 
demic Cholera, whose fatality is materially 



10 ASIATIC CHOLERA. 

varied by the seasons of the year ; the 
greatest being usually at the close of Sum- 
mer or the beginning of Autumn. There 
are, in short, many points of resemblance 
in this and former epidemics to that of the 
Cholera, which naturally lead to the sup- 
position that all have had a common origin, 
if, indeed, they be in many respects dissim- 
ilar. 

Their pestilential character, their ex- 
tended influence, and their great fatality, 
rendered their appearance and progress a 
special terror to physicians, and melancholy 
apprehension to the people. They seem to 
have been regarded as the manifestation of 
an invisible power, which directed and 
guided " the pestilence that walketh in 
darkness " and " the destruction that 
wasteth at noon-day ; " a visitation or chas- 
tisement over which human ingenuity and 
medical skill had little control. Under 
these impressions, the earlier physicians 
labored and endeavored to satisfy the great 
mass of mind that these occasional and 
special developments of disease arose from 



ORIGIN AND DEVELOPMENT. 11 

natural causes, and were subject to eertaim 
natural laws. They ascribed their origini 
to the commingling of some specific poison; 
in the food, and drink, and air, which,, 
through these " media/ 7 was received into* 
the system. 

Subsequently, they seem to have madb 
some advance on this theory, and consid- 
ered the extreme Summer heat — especially 
the intense heat of the sun in a dry season 
— the emanations from stagnant waters, 
and the miasm exhaled from the soil, and 
from putrid bodies of animals, as the chief 
causes of all epidemics. These views pre- 
vailed for a very long period, and have^ 
undergone no very remarkable change from: 
the observations and discoveries of centu- 
ries. 

Modern and quite recent writers have 
advanced nearly the same doctrines, em- 
bracing, however, the principal sources of 
insalubrity — the malarious and miasmat- 
ic influences; and have assigned as the 
cause of epidemics, especially that of Chol- 
era, a peculiar constitution of the atmos- 
2 



12 ASIATIC CHOLERA. 

phere, and certain predisposing causes com- 
bining with each other, so that an associa- 
tion or union of these two independent and 
individual causes are necessary and essen- 
tial to the production of the disease. 

Eminent scholars and pathologists have, 
during the century last past, patiently 
searched for its final cause, without arriving 
at any better, wiser, or more satisfactory 
conclusion than the earlier writers, who 
regarded it a poison, commingled with the 
food they ate, the water they drank, and 
the air they breathed. The modern writers, 
according to the more popular views, 
almost universally adopt the hypothesis 
that the remote or final cause of the Chol- 
era is a specific poison ; for at no period 
has a person in good health in this or any 
other country been known in a few minutes 
to be shriveled up, his face and extremi- 
ties to turn purple, his whole body to be- 
come of an icy coldness, and with or without 
vomiting a peculiar fluid, like rice-water, 
to die in a few hours, except under the in- 
fluence of poison. That this disease, so 



ORIGIN AND DEVELOPMENT. 13 

appalling and destructive in its effects, and 
so mysterious in its wanderings, should 
spread over countries in respect to climate, 
soil, geological formations, and as to the 
moral and physical habits of the population, 
so utterly opposite to those where it first 
originated, is only explicable on the hypoth- 
esis of its propagation on the principle of 
a specific disease — poison. 

How and in what manner it travels has 
not been s atisfactorily determined. Whether 
independent of any and all human agency, 
or absolutely dependent on ordinary com- 
munication and intercourse of tribes, and 
peoples, and nations, is as yet unsettled. It 
is, however, a matter not of so much conse- 
quence as the fact that, in all its nomadic 
life, it retains unchanged its youthful dis- 
position, vigor and energy. It seldom shows 
any inclination to associate, or coalesce, or 
even adopt the milder habits- and manners 
of others. 

Perhaps some idea of its character may 
be obtained from a microscopic view of its 
birthplace and its surroundings. Whether 



14 ASIATIC CHOLERA. 

the locality of its irruption in 1629, or that 
of 1817, whence it spread over the greater 
part of the globe, be entitled to the unen- 
viable distinction of fostering its gestation, 
concealing and protecting its birth, and 
nursing its infancy, is immaterial ; — since 
the similarity of these localities strikingly 
illustrates its cause and ultimate develop- 
ment. 

On the north side of the island of Java, 
about 6° 8. lat. and 107° E. long., near the 
mouth of the river Jacatra, is situated Ba- 
tavia, in the midst of swamps and marshes, 
surrounded by trees and jungle, which 
prevent the exhalations from being carried 
off by a free circulation of the air, and 
render the town peculiarly obnoxious to 
marsh miasmata. Besides this, all the prin- 
cipal streets are traversed by canals, planted 
on each side with rows of trees, over which 
'there are bridges at the end of almost every 
street. These canals are the common recep- 
tacles for all the filth of the town. In the 
dry season their stagnant and diminished 
waters emit a most intolerable stench, while 



ORIGIN AND DEVELOPMENT. 15 

in the wet season they overflow their banks 
and leave a quantity of offensive slime. 
From these united causes, it is not surpris- 
ing that Batavia has been considered the 
most unhealthy spot in the world, and has 
been designated the store-house of disease. 
According to Raynal, the number of sailors 
and soldiers alone who died in the hospitals 
averaged 1,400 annually for sixty years, and 
the total amount of deaths in twenty-two 
years exceeded a million of souls. The city 
was inclosed by a wall of coral rock, with 
a stream of water on each side within and 
without. Tew Europeans, however, sleep 
within the town, as the night air is consid- 
ered very baneful. The inhabitants, pos- 
sibly, as an antidote against the noxious 
effluvia arising from the swamps and canals, 
continually burn aromatic woods and resins, 
and scatter about a profusion of odoriferous 
flowers, of which there are great abundance 
and variety. During the prosperity of the 
Dutch East India Company, Batavia ob- 
tained the title of Queen of the East, as the 
resources of all other districts were sacrificed 
2* 



16 ASIATIC CHOLERA. 

to its exclusive commerce. Here, in this 
noted locality, was the Cholera bred and 
reared in 1629, under circumstances of great 
significance, admirably adapted to convey 
some idea of its cause and character. 

A learned professor, speaking of the 
diseases of India, observes : " Cholera is the 
most acute of acute diseases. It seems to 
have existed in Batavia as far back as 1629 ; 
and it has been known to prevail as an oc- 
casional epidemic in India at different years 
and places from 1774 to 1817. Since then 
it has been endemic, and is a disease whose 
germs are essentially maintained in, or upon 
the soil. It annually recurs at many of our 
large stations, commencing generally at the 
beginning of the hot season, but sometimes 
occurring in the rainy and cold season. 
Its greatest proclivity to propagation is 
amongst populations living in low, damp, 
crowded, and ill-ventilated situations, es- 
pecially if the water supply is impure. 
Nearly all the diseases fatal in India are 
accompanied by profuse discharges, with 
which the air, water, linen, bedding, closets, 



ORIGIN AND DEVELOPMENT. 17 

walls of hospitals, and barracks become more 
or less infected ; so that the ' Materies Morbi 7 
come into contact with all the inmates of 
buildings where the disease prevails. 77 

Its origin, or reappearance in 1817, is not 
in any respect essentially different from its 
earlier development on the Jacatra. The 
River Ganges, in India, like the Nile in 
Egypt, flows for a long distance through a 
low, level country, which it annually inun- 
dates. Dividing its waters about 200 miles 
from the sea, the Delta of the Ganges com- 
mences and continues its variegated and 
checkered surface, till, approaching the bor- 
ders of the sea, it presents a peculiar aspect, 
being composed of a labyrinth of creeks and 
rivers, called " The Sunderbunds, 77 with 
numerous islands, covered with the profuse 
and rank vegetation called " jungle, 77 af- 
fording haunts to numerous tigers and other 
beasts of prey. This large river, " a Deity 
of the Hindoo, 77 is subject to an annual 
freshet, often rising to the height of 32 feet 
in the month of July ; when all the lower 
parts of the country adjoining the Ganges, 



18 ASIATIC CHOLERA. 

as well as the Burrumpooter, are overflowed 
for a width of one hundred miles ; nothing 
appearing but villages, trees, and sites of 
some places that have been deserted. Here 
in this vast pest-house, where every conceiv- 
able vegetable and animal substance is left 
upon the soil by the retiring inundation, 
exposed to the heat and dews of a tropical 
climate — where, too, noisome and infectious 
diseases have prevailed for centuries, the 
Epidemic Cholera is said to have arisen- and 
acquired its strength and full development. 
A fit origin for a fatal and devastating pesti- 
lence. 

To this low, insalubrious, and festering 
locality, this vast pest-house, where so many 
noxious and noisome diseases are gener- 
ated, and where so many epidemics have 
arisen and so often swept over the surround- 
ing regions with most fatal and desolating 
effects, is ascribed the birthplace of the Epi- 
demic Cholera of 1817. Here it is said to 
have first made its appearance at Jessore — a 
populous town in the centre of the Delta of 
the Ganges ; whence attaining its growth 



ORIGIN AND DEVELOPMENT. 19 

and power, it has extended its influence as 
from a common centre, and marked its prog- 
ress with hecatombs of victims in the direc- 
tion of almost every point of the compass. 
Here we may remark, that it is not our 
intention to travel over the whole ground 
embraced by the subject under considera- 
tion ; but, on the contrary, to present in this 
treatise only a cursory view of a few prom- 
inent features which may interest and aid 
in the important object of deducing from 
the pathology and the varied phenomena of 
the Cholera some general principle of prac- 
tice. For this, and to this, our labor and 
our investigations are directed. Availing 
ourselves of every source of information 
within our reach, and relying in part on the 
observations and experience of others, we 
shall aim to present such facts and argu- 
ments as will shed light upon the subject, 
and aid in the accomplishment of this de- 
sirable object. However difficult this may 
appear, it is nevertheless believed to be 
within the province of science and unbiased 
reason. 



20 ASIATIC CHOLERA. 



Section II. — Progress and Fatality. 

The disease in 1817 appeared on the 
Delta of the Ganges, and gradually extend- 
ing its influence, swept over various coun- 
tries with terrible severity. Having here 
acquired its full development, and manifest- 
ing an indomitable determination to itiner- 
ate, it starts upon its lethean errand, and 
soon shows a capacity and power to over- 
come every obstacle opposed to its progress, 
and to pursue its course unchecked and 
even unretarded by any natural or artificial 
barrier. It soon traversed India, and in 
the succeeding season spread over adjacent 
countries, visiting in 1818 the Indian Pen- 
insula, the Burmese Empire, the Kingdom 
of Aracan, and the Peninsula of Malacca. 
In 1819 it reached Sumatra, Singapore, and 
various other islands situated along the 
coast on either border of this vast peninsula. 

During the year 1820, pursuing steadily 
its progress eastward, it reached Tonquin, 
Southern China, Canton, the Philippine, and 



PROGRESS AND FATALITY. 21 

numerous other places and islands in that 
direction. In 1821 it visited Java — the 
place of its earlier nativity — Madura, Bor- 
neo, and many other places in the Indian 
Archipelago. During the years 1822, 
1823 and 1824, it continued to spread 
over the vast and populous regions of Cen- 
tral and Northern China and the numerous 
islands upon the coast, and in 1827 pre- 
vailed in Chinese Tartary, leaving few 
places in all these different countries on the 
continent, or even on the islands bordering 
on the eastern coast, unscathed by its terri- 
ble ravages and depopulating influence. 

During the same period, its progress 
westward has been uninterrupted, and at- 
tended with results no less remarkable. It 
has baffled all attempts to check or even 
retard its onward course, or mitigate its 
appalling effects. In July, 1821, it had 
reached Muscat in Arabia, and thence ex- 
tended its influence to the populous cities 
and villages along the Persian Gulf. Dur- 
ing the same season it appeared in Persia, 
and continued to ravage the principal cities 



22 ASIATIC CHOLERA. 

and towns of that empire for four successive 
years. At Bassorah and Bagdad it broke 
out in July, 1821, and thence extended its 
desolating influence westward to the Red 
and Mediterranean Seas, carrying off vast 
numbers of the inhabitants of the populous 
cities of Mesopotamia, Syria, and Judea. 

In 1822 it prevailed among the nomadic 
and Tartar tribes in Central Asia and in 
the northern Persian Provinces, and in 1823 
broke out on the Georgian frontiers of Rus- 
sia, at Orenburg on the River Ural, and at 
Astrachan on the Volga. Here its western 
course was apparently interrupted. There 
was, for a short period, an interval of com- 
plete immunity from its presence. Along 
the border of the Russian Provinces the 
disease had entirely disappeared, and seemed 
inclined to retrace its course and return to 
the home of its birth. But the fond antici- 
pations of Europeans were disappointed ; 
the destroyer was not to be arrested and 
turned back in his progress over the earth ] 
his march was onward, his demands imper- 
ative. 



PROGRESS AND FATALITY. 23 

Hence, in the month of June, 1830, the 
disease reappeared in a Persian province 
on the southern shore of the Caspian, and 
again at Astrachan, on the Volga, in July, 
where it prevailed with such unwonted vio- 
lence that, before the close of August, more 
than 4,000 persons had died of it in the city, 
and 21,270 in the province. From its in- 
terval of repose, it would seem to have re- 
cuperated its strength and vigor for the 
lethean work awaiting its progress. 
Ascending the Volga, it reached Moscow, 
became prevalent there in September, and 
continued with great severity till February, 
1831. Here it attacked, in the city, about 
9,000 persons, of whom more than one-half 
died. Continuing its advance, it reached 
Riga about the middle of May, and St. Pe- 
tersburg on the 26th June. 

From Astrachan it also directed its course 
towards the northern coast of the Black Sea, 
and thence along the course of the rivers 
into the central parts of Russia. It reached 
Poland in January, 1831, accompanied the 
Russian army in its various marches and en- 
3 



24 ASIATIC CHOLERA. 

campments during the subjugation of that 
country, and proved very destructive in 
Warsaw and many other places during 
April and May. It appeared at Dantzic in 
May, and in June at Lemburg, Cracow, and 
various other places and sections of country, 
extending through Gallicia, Hungary, and 
reaching Berlin and Hamburg in August 
and September, and Vienna about the same 
time. 

Smyrna was visited in September, and 
Constantinople soon afterwards. It is re- 
ported that the pestilence was conveyed by 
a caravan from Mecca to Cairo in August, 
1831, some thousands having died on the 
road ; and, by the middle of September, 
10,400 Mohammedans, besides Jews and 
Christians, had died of it in this latter city. 

Passing from the western coast of the 
continent, on nearly the same parallels of 
latitude, it found its way over the Northern 
Sea to the British Isles, and made a lodg- 
ment, first, on the northeastern coast of 
England, in October, 1831, at Sunderland, 
situated in latitude 55° north, whence it 



PROGRESS AND FATALITY. 25 

prevailed and extended its influence over 
this section, evincing the same malignant 
and lethean character it had manifested in 
its progress over the continent. Its course 
thus far has been marked with unparalleled 
fatality. 

It made its first appearance in Scotland, 
at Haddington, in December, 1831, and at 
Edinburgh in January. In these and vari- 
ous other places it prevailed for some 
months, and, as warm weather came on, in- 
creased in severity, and carried off a large 
percentage of those attacked. After spread- 
ing thus over the northern section, and riot- 
ing for months in the more populous cities 
and towns, it made its appearance in Lon- 
don on the 14th February, 1832, where it 
found an abundance of material for recuper- 
ating its strength and multiplying its forces, 
and soon after spread over various other 
places in the United Kingdom, inflicting the 
most appalling bills of mortality. In short, 
its progress over this country has been at- 
tended with the same destructive influence 
and the same lamentable consequences as on 



26 ASIATIC CHOLERA. 

the continent. No change, modification, or 
softening of its disposition or character has 
arisen from its passage over the Northern 
Sea, nor from the refreshing influences of a 
purer atmosphere. 

It appeared in Calais on the 12th, and at 
Paris on the 26th of March, 1832, where it 
continued in these and other cities and vil- 
lages for some months with its accustomed 
severity. During the season it raged 
throughout the vast empire, and swept away 
an immense number of its inhabitants. Dur- 
ing the succeeding years, 1833 and 1834, it 
traversed Spain, and proved very destruc- 
tive in many of its larger cities and vil- 
lages. 

In the mean time, continuing its course 
from the British Isles westward, unchecked 
by the prevailing western winds and the 
broad expanse of the Atlantic Ocean, over 
which it passes a distance of nearly three 
thousand miles, and makes its first appear- 
ance on the American continent at Quebec, 
Lower Canada, on the 8th June, 1832, and 
reaches Montreal on the 10th of the same 



PROGRESS AND FATALITY. 27 

month. From these cities it rapidly spread 
in all directions, prevailing in the towns and 
villages on the St. Lawrence and its tribu- 
taries, and soon extended along the chain of 
lakes, dividing the Provinces from the 
United States, visiting the principal ports 
on either shore. It exhibited in all these 
places its peculiar epidemic character, and 
proved excessively violent and fatal where- 
ever it appeared. 

Its first irruption in New York was on 
the 24th June, 1832, sixteen days after its 
appearance at Quebec, and at Albany, mid- 
way between the two former cities, on the 
3d July. From New York it extended its 
influence to Flatbush and Gravesend, Long 
Island, where it appeared on the 5th July, 
and on the same day and date at the city of 
Philadelphia. It broke out at Rochester on 
the 12th and at Buffalo — July. 

Thus, while it was making its way west- 
ward along the great chain of lakes, towards 
the arteries of the Great West, it was, at 
the same time, steadily pursuing its uninter- 
rupted course along the coast, visiting the 
3* 



28 ASIATIC CHOLERA. 

main cities, and spreading from these as 
from common centres over the intermediate 
towns and villages. In its progress it 
reached Baltimore on the 22d August, and 
the City of Washington on the 28th of the 
same month. 

Thence it continued its course to Rich- 
mond, Norfolk, Edenton, and various other 
cities along the Atlantic and Gulf coast. 

It appeared at New Orleans in the Autumn 
of 1832, during the existence of a severe 
epidemic of yellow fever, and apparently 
subsided on the disappearance of the fever, 
Sporadic cases, however, occurred during 
the Winter, and in the opening of Spring it 
broke out with unwonted vigor and severity, 
and thence spread, according to its accus- 
tomed laws of itineracy, along the rivers 
into the interior of the States bordering 
upon the Mississippi and the Gulf coast, and 
raged throughout Louisiana and Texas with 
unusual violence and fatality. 

In 1832, 1833, and 1834 it prevailed 
throughout the Mississippi Valley with 
great fatality, especially in the principal 



PROGRESS AND FATALITY. 29 

cities, villages and towns situated upon its 
navigable waters. Here, after intervals of 
entire immunity from its presence, it occa- 
sionally reappeared in some of the larger 
cities with renewed vigor and power, and 
swept off vast numbers of the inhabitants. 
In no section of the States have greater 
numbers, compared with the whole popula- 
tion, fallen victims to it than in 'the fertile 
and sparsely settled prairies of the South 
and West. 

Thus, from the North, and at a later date 
from the South, extending its influence along 
the principal rivers into the interior, it 
swept over the States, prevailing in some 
places in the Valley of the Mississippi as 
late as 1836. In short, it reappeared in 
1834 in many cities and places where it had 
before prevailed, and again spread over a 
considerable portion of the country with 
unprecedented fatality. 

In 1833, the disease appeared at Havana 
and Matanzas, and prevailed on the island 
for several months with great fatality, espe- 
cially among the colored people. During 



30 ASIATIC CHOLERA. 

the same season it appeared in August at 
Tampico, Campeachy, Vera Cruz, and the 
city of Mexico, proving especially violent 
and destructive in these and other cities of 
the Republic. In Central America it is 
said to have attacked the army, and in a 
very short period to have swept away a very 
large proportion of its officers and men. 

Thus, it appears that the epidemic or 
Asiatic Cholera, from its first irruption on 
the northern coast, spread over the greater 
part of the North American Continent in 
the space of two years, and has several 
times reappeared in different sections in its 
peculiar malignant character, spreading on 
each occasion over a greater or less extent 
of territory with the same uniform and de- 
structive influence. Neither time, nor 
science, nor professional skill has thus far 
appeared to soften its character, or mitigate 
its severity. 

When the disease had fully assumed its 
epidemic or malignant type in India, in 
1817, its rate of mortality was everywhere 
in that vast territory excessively high. 



PROGRESS AND FATALITY. 31 

According to the most reliable reports, the 
cases occurring in the earlier period of an 
irruption were generally fatal, few only 
surviving the attack ; while of those oc- 
curring when the disease was on the decline, 
a greater proportion recovered. We read 
of numerous instances where one-third, one- 
half, two-thirds, and even nine-tenths of 
those seized with Cholera perished, and 
again of some places where one-fifth, one- 
fourth, and in some instances one-third of 
entire populations were cut off in a very 
short period by this disease. But without 
attempting to give the statistics of cholera 
in this part of the world, or even in Europe 
or America, we may present a few instances 
of mortality, going to show the great per- 
centage of loss by this singular disease dur- 
ing its ravages from 1817 to 1831. 

In Siam, it is said 20,000 persons fell 
victims to it in twelve days. The inhabi- 
tants are remarkable for their uncleanly 
habits, and crowded, ill-ventilated tene- 
ments. 

In Sicily, 16,000 died of cholera in 1832, 



32 ASIATIC CHOLERA. 

at Cataria ; in Palermo, 40,000. These 
cities are represented as being filthy in the 
extreme, and the personal habits of the peo- 
ple so uncleanly, and the houses so crowded, 
that it is a matter of surprise the mortality 
was not greater. 

In Bassorah and Bagdad, situate in low, 
unhealthy localities, and exposed to a damp, 
insalubrious atmosphere, which, in the 
warmer season, is often essentially impreg- 
nated with miasmata and offensive exhala- 
tions from animal and vegetable decompo- 
sition, both within and without their inci- 
sures, it is affirmed that more than one-third 
of their entire populations were carried off 
in less than one month. 

In the Province of Caucassus, out of 
16,000 attacked by the disease, 10,000 died. 
In Russia, out of 54,000 attacked in 1830, 
it is said more than 31,000 died. 

In Hungary, it is reported that the whole 
number affected by the disease was about 
400,000, of whom more than one-half died. 

It is officially stated that the total num- 
ber — the military excepted — of those affect- 



PROGRESS AND FATALITY. 33 

ed with cholera in France, from its first ap- 
pearance at Calais, March 15, 1832, to Jan- 
uary 1st, 1833, is 230,000, and the deaths 
95,000. 

In England, the whole number of cases 
of Cholera is reported to be 49,594, and the 
number of deaths 14,807. In London there 
were 11,020 cases, of which 5,274 were 
fatal. In Wales there were 1,436 cases, of 
which 498 proved fatal. In Ireland, from 
its first irruption in 1832 to March, 1833, 
there had occurred 54,552 cases of cholera, 
of which 21,171 were fatal. 

In Quebec, from June 9 th to September 
2d, 1832, there had occurred in that city 
alone no less than 5,783 cases of cholera, of 
which 2,218 were fatal. In Montreal, from 
June 10th to September 21st, there were 
4,440 cases, and 1,904 deaths reported. 

In New York, from July 4th to August 
28th, in 1832, there had occurred 5,814 
cases of cholera, and 2,935 deaths by the 
same disease. In Philadelphia, from July 
4th to August 28th, 1832, there were re- 
ported 2,314 cases of cholera, of which 935 
were fatal. 



34 ASIATIC CHOLERA, 

In many of our Southern and Western 
cities and villages the percentage of loss 
from the prevalence of cholera is consider- 
ably higher than the general average, com- 
pared with the data given above. The mor- 
tality varies materially in different locali- 
ties, and, indeed, becomes very much aug- 
mented by the prevalence of those influences 
which particularly favor the vegetation, and 
are especially concerned in the production 
of zymotic diseases, whether in the lower or 
higher latitudes. 



Section III. — Causes — Propagation. 

The remote or final cause is essentially 
of miasmatic origin, developed under cer- 
tain atmospheric and terrestrial local con- 
ditions, not well defined or fully under- 
stood. In its nature and essence, it 
constitutes a peculiar disease - poison, 
which is now generally admitted to be, in 
one way or another, absorbed, and infects 
the blood, inducing a primary disease of 



CAUSES — PROPAGATION. 35 

this vital fluid, and directly depressing and 
deranging the ganglionic system of nerves.. 
To its general character, and the circum- 
stances under which it is generated and in 
which it operates in producing the disease,, 
we have alluded in speaking of its origin. 

The predisposing causes are as numerous 
as the varied influences which operate to 
depress the general health. The insalu- 
brity of the atmosphere may be regarded 
as a general, and, perhaps, the most exten- 
sive predisposing cause. In this state, its 
vital element becomes diminished or im- 
paired to such an extent as to render it 
incapable of sustaining the normal and 
healthy functions of the system in their 
most vigorous condition. Hence, the foul 
and noisome air of close, ill - ventilated 
apartments becomes very depressing and 1 , 
baneful ; a direct and effective element,, 
often, in constant operation in generating- 
and producing the cholera, typhoid fever,, 
or other deadly maladies. This is not un-~ 
frequently the case on board some of our 
emigrant ships, when hundreds of human 
4 



36 ASIATIC CHOLERA. 

beings arc stowed away between decks 
without the means of efficient ventilation, 
disinfection, or other mode of expelling the 
noxious principle. Though the germ of 
disease may be ever on board, it does 
not vegetate and come forth and rapidly 
acquire its activity, vigor and power, unless 
the localizing influence vivify, foster and 
nurture its development. This is fully con- 
firmed by the recent arrival of two steam- 
ers with cholera on board. 

The England, and a few days later the 
Virginia, with crews and passengers all in 
perfect health, departing from a healthy 
port where no cases of cholera were known 
to exist, and after being out at sea six or 
eight days under the influence of a cool, in- 
vigorating atmosphere, were surprised by 
the sudden irruption of cholera on board. 
It breaks out among the steerage passen- 
gers who are crowded and packed together 
between decks like sheep for the slaughter, 
in a confined atmosphere, daily becoming 
more noisome, without the means of venti- 
lation or disinfection. Can any sane man 



CAUSES — PROPAGATION. 37 

say the disease — the cholera — was not here, 
on board these ships, generated and pro- 
duced ? 

This is also confirmed by the occurrence 
of an isolated case on Ninety-third Street, 
near Third Avenue, the first case in this city 
this season. Though the cholera exists at 
Quarantine, the patient had not been in any 
way exposed to the disease, except to the 
exhalations from the overflowing and drain- 
age of a privy and the foul atmosphere 
arising from the cellar of her own tenement. 
On Monday, it is said, she partook of her 
dinner, feeling a little indisposed ; at 4 p. m. 
she called in her physician, and died the 
next morning, May 1st, at 11 a. m., in a 
state of collapse. 

Take another instance : the second case 
in this city occurred in one of the tenement 
dwellings of the Sixth Ward, No. 117 Mul- 
berry Street. The patient was a woman 
about thirty years of age, who had not been 
exposed, except to the noisome atmosphere 
of her own dwelling and its surroundings, 
which must be regarded, under the peculiar 



38 ASIATIC CHOLERA. 

circumstances, &s a true, genuine cholera 
atmosphere. In these cases the evidence is 
conclusive that the disease was generated 
and produced within, and on these prem- 
ises. 

The exhalations from low, moist, and 
marshy localities, from the offensive cess- 
pools, water closets, sinks, sewers, and the 
decomposition of animal and vegetable sub- 
stances, from the refuse or garbage which 
so often befouls the sidewalks and gutters 
of streets, are all effective, predisposing 
^causes, that directly facilitate the produc- 
tion of the cholera. Whatever tends to de- 
press the vital powers, impair normal 
action, or relax in any degree the tone of 
the nervous system, favors the operation of 
the final cause. So, too, the low, under- 
ground, damp, unventilated apartments, the 
crowded and uncleanly tenement houses, 
in which multitudes of the poorer class live, 
in a confined, foul, and noisome atmosphere, 
not only favor, but actually invite, the ac- 
tive operation of the infecting agent. 

Habits of intemperance, profligacy, im- 



CAUSES — PROPAGATION. 39 

purity, and late hours, have a powerful in- 
fluence to depress and prepare the system 
for an invasion of the disease in its most 
malignant form. In a neighborhood of this 
description, when the cholera in 1832 was 
raging in the adjacent city, from which it 
was separated by a very small creek, the 
uncleanly multitude escaped entirely, not 
a case occurring there at that time ; but 
when, after an interval of several weeks, all 
danger seemed to have passed, and the peo- 
ple were rejoicing and congratulating 
themselves on their good fortune, the fear- 
ful disease suddenly appeared in their midst 
with greatly intensified effect, and in a very 
few days swept the place so clean that few 
were left to tell the sad story of its ravages. 
There are some other predisposing causes 
of no inconsiderable influence, which not 
only favor the operation of the infecting 
agent in the production of the disease, but 
even awaken its latent power, and stimulate 
its activity and development in the system, 
once exposed to its invasion. Among these, 
excessive fear of an attack, great anxiety and 
4* 



40 ASIATIC CHOLERA. 

depression of mind, constitutional debility, 
deranged condition of the digestive organs, 
accompanied with a relaxed state of the 
bowels, exhaustion arising from fatigue or 
disease, semi-starvation and unwholesome 
diet, neglect of personal and domestic 
cleanliness, irregular habits, and excesses 
of every description, are all direct incen- 
tives and stimulating agents in the pro- 
duction of the cholera. Any one of these 
may be sufficient to induce an attack ; but 
when a number unite and act conjointly 
the danger is vastly greater, as the infecting 
agent or disease - poison becomes thereby 
more intensified. 

When the cholera first appeared in Eu- 
rope and in this country in its epidemic 
form, the majority of medical men, as well 
as the people, believed it to be contagious, 
and to be propagated solely on this princi- 
ple. But when the disease appeared in 
1848 a decided change of opinion occurred, 
which led to a full discussion of the subject, 
without any definite result ; and the great 
question as to its contagious character and 



CAUSES — PROPAGATION. 41 

its mode of propagation remains still un- 
settled. The higher authorities, says an 
eminent author, concurred in the opinion of 
the Board of Health, " that the disease was 
not in any way contagious, and that no 
danger was incurred by attendance on the 
sick." 

A large body of evidence, however, has 
been exhibited, going to show that human 
intercourse has, at least, a share in the prop- 
agation of the disease, and that it, under 
some circumstances, is the most important, 
if not the sole means of effecting its diffu- 
sion. On the other hand, it is affirmed that 
though it may be communicated, in some 
cases, by the agency of human intercourse, 
it does not follow that the material cause 
spreads by true contagion, that is, by repro- 
ducing itself in the bodies of men, and there 
only. 

The disease may be carried by healthy 
persons in their clothing, in their ships, and 
in their caravans. That instances of this 
kind have occurred there can be no ques- 
tion, for numerous records present some un- 



42 ASIATIC CHOLERA. 

doubted instances of the occasional commu- 
nication of the cholera-poison through hu- 
man intercourse ; still it is no less certain 
that its general extension over the world 
cannot be accounted for on this principle 
alone. " Its propagation by this means 
seems to be the rare exception, its spread 
over the earth from other causes being the 
common rule." 

Dr. Hamlin, writing from Constantino- 
ple, in reference to the recent irruption and 
prevalence of the cholera in that city, ob- 
serves, " The idea of contagion should be 
abandoned. All the missionaries who have 
been most with the most malignant cases, 
day after day, are fully convinced of the 
non-contagiousness of the cholera. The in- 
cipient attacks which all have suffered from 
are to be attributed to great fatigue, making 
the constitution liable to an attack." 

It is a very singular fact, that the medical 
profession in India, the birthplace and home 
of the cholera, almost universally reject the 
doctrine of contagion. If those most ob- 
servant and familiar with its history, its 



CAUSES — PROPAGATION. 43 

prevalence, and its annual recurrence as an 
endemic disease, which they are called to 
treat in all its varied phases, have discov- 
ered no contagious character by which it 
can be propagated, it may be safely inferred 
that it is not contagious in the common ac- 
ceptation of the term, and that its extension 
over the earth is governed by some other 
principle, and that the predisposing and 
localized causes which are always in opera- 
tion in India exercise no small share in its 
diffusion, in directing its course, aggravat- 
ing its severity, increasing or diminishing 
its fatality, and determining the duration 
of its prevalence in particular localities. 
When its infecting germs have gained a 
lodgment in any city, section, or country, 
they may be stimulated and become exceed- 
ingly active in the production of the disease 
through these influences. 

As to its introduction into' different coun- 
tries, it is quite evident that the germ, or 
latent principle of the cholera-poison, exists 
in such a state as to be capable of trans- 
portation, and may in this way be diffused 



44 ASIATIC CHOLERA. 

to almost any extent when the localizing 
influences are sufficient to develop its ener- 
gies. 

In this, as in all other zymotic diseases, 
some persons are more susceptible of an 
impression and more liable to an attack 
than others. Though no class can be con- 
sidered exempt, yet there are some whose 
organization, or innate protective principle, 
seems to render them impervious to its influ- 
ence. The cholera, however, is no respecter 
of persons, or rank, or condition. The 
ansemic and cowardly in all ranks and con- 
ditions are peculiarly liable, and are the 
most defenceless and unresisting when in- 
vaded. In Europe, the probable numbers 
attacked in that part of the world appear 
from statistics to be, in France, as 1 in 300 ; 
Russia, as 1 in 20 ; Austria, as 1 in 30 * 
Poland, as 1 in 32 ; Holland, as 1 in 144 ; 
Germany, as 1 in 700. " The circumstance 
of one attack by no means protected the in- 
dividual lrom a second in the same, or any 
subsequent year ; still a repetition of the 
disease in the same person in the same year 



PATHOLOGY. 45 

CHAPTER II. 
Section I. — Pathology. 

The doctrine now universally accepted 
and prevailing regarding its Pathology is, 
that a poison, virulent, subtle, and unknown, 
has been absorbed, and primarily infects the 
blood, so that, after a longer or a shorter 
time, a primary disease of this vital fluid is 
produced, and that the poison undergoes an 
enormous process of multiplication in the 
living body of the cholera patient, as the 
direct result of this morbific process so estab- 
lished, and that changes are induced in the 
function of respiration directly consequent 
on this alteration of the blood. 

This altered condition and rapid change 
in the life-sustaining principle of the blood, 
the loss of nerve-power, the impaired circu- 
lation and tendency to congestion, are the 
proper and distinguishing features of the 
disease ; and the term " Algide," first used 
by the French Pathologists, very happily 



46 ASTATIC CHOLERA. 

describes one of the most remarkable and 
constant symptoms, namely, the diminution 
of animal heat. The loss of temperature 
and its consequent effects upon the circula- 
tion, depressing and prostrating the nervous 
power, impairing and paralyzing the respir- 
ator y organs, suspending the functions of 
the liver and kidneys, enfeebling the action 
of the heart, and causing the capillary ves- 
sels of the mucous- tissues to expand and 
pour off the serous fluid from the blood and 
every muscle and tissue of the system, with 
great rapidity, essentially constitute the phe- 
nomena of the Cholera. The constantly 
increasing augmentation of the poison and 
its intensified effects measure the malignity, 
the violence, and the rapidity of the dis- 
ease. 

It is this multiplication, and the disturb- 
ance which attaches to it, that in each case 
constitutes the disease and destroys life. 
Of this fact the circumstantial evidence is 
abundant and conclusive, and may account 
in part for the violence of the disease in its 
first irruption in any particular locality. 



PATHOLOGY. 47 

The vomiting, purging, and cramps are now 
generally considered as secondary and non- 
essential phenomena, for numorous cases of 
cholera have occurred in every section 
where it has prevailed in its more violent 
and malignant form without exhibiting 
these symptoms. The poison was so potent, 
and its progress so rapid, that life was ex- 
tinguished in a very short time. In its first 
irruption at Muscat, cases are reported in 
which only ten minutes elapsed from the 
first apparent seizure before life was extinct. 
Dr. Milroy, speaking of the violence and 
rapidity of the disease as it occurred in 
1817, and again in 1845 and '6, at Kurra- 
chee, observes, that " within little more than 
five minutes hale and hearty men were 
seized, cramped, collapsed, and dead." In- 
stances of death taking place in two or 
three hours are extremely common. When 
it broke out at Teheran, in May, 1846, Dr. 
Milroy observes, that " those who were at- 
tacked dropped suddenly down in a state of 
lethargy, and at the end of two or three 
hours expired, without any convulsions or 
5 



48 ASIATIC CHOLERA. 

vomitings, but from a complete stagnation 
of the blood.' 3 In many places during its 
prevalence in 1832, and subsequently in 
1834, and in 1848 and '9, the rapid fatal 
character of the earlier cases was observed 
and reported as the most severe and hope- 
less. In various cities and villages in our 
own country, cases of this description were 
not unfrequent. In all these the destructive 
nature and rapid process of the disease was 
so depressing and overwhelming as to pre- 
vent any effort of the " vis naturae" to resist 
its progress. 

Hence, from the autopsy of those who 
have fallen victims to its baneful influence 
in the first stage, or within forty-eight 
hours of the attack, no alteration of struc- 
ture in any organ or tissue has been dis- 
covered. But in those cases where death 
has occurred at a later period, some lesions 
and slight changes in the appearance of 
some tissues have been traced. The more im- 
portant of these, illustrative of the charac- 
teristic effects of the disease, are, in brief, 
the following : 



PATHOLOGY. 49 

The follicular structure of the intestinal 
canal has been found slightly swollen, and 
the intestine partially filled with a turbid, 
inodorous, semi-diaphanous fluid, resembling 
thin starch, or rice - water, and is sup- 
posed to be the remains of that peculiar 
secretion which had taken place during life. 
This fluid is sometimes acid, and sometimes 
alkaline. In the small intestines it is 
found in an unmixed condition. It consists 
of two liquids of different consistency ; the 
one thick, the other thin. The latter con- 
stitutes the rice-water stools, and may be 
passed off without admixture with the 
thicker substance. The colon has been 
found generally much contracted, and the 
mucous membrane and the sub-mucous cel- 
lular tissue of the digestive canal present- 
ing evident marks of congestion, in some 
cases approaching to a sub - inflammatory 
state, generally in spots or patches of various 
sizes, the color of these varying from a 
very dark congestion to a more roseate hue. 
The glands of Brunner and Peyer, as well 
as the solitary glands, are greatly enlarged. 



50 ASIATIC CHOLERA. 

The stomach and bowels are frequently of 
a paler color than natural, both in their 
inner and outer surfaces. The liver, the 
spleen, and the kidneys have been found 
engorged with blood. The urinary bladder 
is always contracted, and empty. The gall- 
ducts are sometimes contracted, at other 
times not. The vena porta and all the other 
abdominal veins are loaded with black blood, 
resembling tar in its color and consistency. 
The membranes of the brain and cord are 
generally found congested, and the substance 
of the brain more or less dotted with 
small points or specks of blood than usual. 
" The most common appearances in the 
lungs," says an eminent pathologist, " are 
the presence of blood in the large vessels, 
chiefly or solely ; the collapse and the defi- 
cient crepitation arising from the more or 
less complete absence of air and blood, and 
from the approximation of the molecular 
parts of the pulmonary substance. In 
other cases there is more blood in the 
minute structure, a corresponding dark 
color of the lung, and a variable amount of 



PATHOLOGY. 51 

frothy serum. The right side of the heart 
and the pulmonary arteries were generally 
filled, and in some cases distended with 
blood ; the left side and aorta were gener- 
ally empty, or contained only a very small 
quantity of dark blood ; the left side evi- 
dently had received little or no blood, but 
had continued to contract, in some cases 
even violently, on the last drop of blood 
which had entered it." 

Such are some of the prominent appear- 
ances which the body has presented when 
the patient has died in the first, or pulse- 
less stage of the disease. But in other 
cases, where the premonitory stage has been 
definitely marked, and attended with diar- 
rhoea or other depressing disorder affecting 
the alimentary canal, and where the patient 
has continued under the influence of the 
disease for a longer period, and has passed 
through the usual successive stages of it, 
other additional appearances have been 
noticed, which are here omitted, as they are 
of a secondary importance, and belong es- 
pecially to the more protracted cases. 
5* 



52 ASIATIC CHOLERA. 

The post-mortem appearances, the pheno- 
mena of the disease, the Algide, or diminish- 
ed animal heat, and the loss of nervous power, 
all tend to sho^y an obstructed circulation 
and consequent embarrassment of respira- 
tion resulting in the non-aeration and non- 
oxydation of the blood, from which a long 
train of secondary and non-essential symp- 
toms arise. For it is affirmed that the me- 
chanical part of respiration remains in a 
good degree perfect, and that the heart evi- 
dently continues to beat in many cases till 
stopped by the want of blood in the left 
side and by its accumulation in the right 
side. Hence, for the cause of this arrest of 
the circulation of the blood through the 
lungs, we are forced to look to the condi- 
tion of the blood itself, and the deranged 
action of the ganglionic nerves. 

Attempts have been made to trace out 
from analysis the exact chemical changes 
in the order of their occurrence which at- 
tend the period of transudation from the 
blood into the intestinal canal. " The most 
prominent phenomena of cholera," says Dr. 



PATHOLOGY. 53 

Aiken, " during this period of transudation, 
consists in separation of the water and of 
the salts of the intercellular fluid (of the 
blood) through the mucous membrane of 
the intestinal canal, and the retention in 
the blood of an important excess of albu- 
men and of blood-cells, with apparently 
less, but in reality with great diminution 
of the salts and fibrin." 

" The inorganic constituents," continues 
the same author, " if compared to the water, 
are during the first four hours increased, 
because at this time the water is passing 
off with great rapidity ; afterwards, as the 
salts pass off, the disproportion is lessened, 
and after eighteen hours or so, the propor- 
tion of salts is greatly diminished, and, if 
compared with the organic constituents, the 
diminution is enormous. With respect to 
the individual salts, there is in the blood a 
relative preponderance of phosphates over 
chlorides, and of potash salts over soda 
salts. By the end of eighteen hours or so, 
the blood-corpuscles arc left in a most ab- 
normal condition ; the great loss of water 



54 ASIATIC CHOLERA. 

and of salts, especially of the chloride of 
potassium — a most important constituent of 
the blood-cells — at once leads to the con- 
clusion that their functions must have 
been greatly impaired. Accordingly, Dr. 
Schmidt found that the amount of oxygen 
contained in them was lessened by one- 
half." Dr. Robertson affirms that the " fib- 
rin of the blood is usually in large amount 
and coagulable with great firmness f while 
Dr. Parkes, speaking of the same condition 
of the blood, and relying on the accuracy 
of his analysis, observes, " The presence of 
fibrin in the blood was not indicated by 
any coagulation either in or out of the 
body ; and whether coagulated or not, the 
blood has usually a dark color ; but it gen- 
erally acquired an arterial tint when 
brought into contact with the air in thin lay- 
ers." * * * " When we remember the great 
share taken by the blood-globules in the 
respiratory and heat-furnishing processes, it 
is scarcely possible to avoid concluding that 
their loss of salts is connected with the 
characteristic cvanosis and lowered tern- 



PHENOMENA, OR SYMPTOMS. 55 

perature in cholera. 27 " The diarrhoea co- 
incides with the first chemical changes in 
the blood — the transudation of some of the 
constituents of the serum." Hence the phe- 
nomena of the disease may thus be traced 
from this process as the starting-point. All 
other chemical changes in the blood, and 
the most marked symptoms, such as the ab- 
normal respiratory process, follow as a 
matter of course. Such is the theory of the 
nature of cholera, now advanced and sus- 
tained by the most eminent pathologists, 
which embraces the doctrine previously ad- 
vanced that the blood is the primary seat 
of the disease, and becomes contaminated 
by the absorption of a specific poison. 



Section II. — Phenomena, or Symptoms. 

The attack of this fearful disease is most 
generally sudden, the patient being at the 
time apparently unconscious of any depress- 
ing influence, or derangement of the system. 
It is not unfrequent, however, that some 



56 ASIATIC CHOLERA. 

slight irregularity of the bowels, loss of 
animation and general vigor, or other ap- 
parently trifling indisposition, have prece- 
ded it. In some instances there are defi- 
nite and decided premonitory symptoms 
which continue for a longer or shorter 
time prior to the attack, commencing usu- 
ally with a pallor or collapse of the coun- 
tenance, depression of spirits, slight pain in 
the forehead, noise in the ears, occasional 
or transient turns of vertigo, slight nausea, 
heat and pain in the epigastrium, oppres- 
sion at the chest, with frequent sighing, 
nervous agitation, some loss of muscular 
power, general uneasiness, flatulence, with 
slight diarrhoea, sickness at the stomach, 
occasional twinges of the nerves, or cramps 
in the extremities, oppressed, small, feeble, 
and sometimes intermitting pulse, coldness, 
clamminess, or humidity of the surface, and 
general lethargy. Such are some of the 
premonitory symptoms which more fre- 
quently occur in the lower latitudes, where 
the general vigor becomes depressed by the 
long-continued and excessive heat of the 



PHENOMENA, OR SYMPTOMS. 57 

climate. Their duration, whenever any of 
them do occur, varies materially ; sometimes 
one, two, or three days — sometimes longer 
but not often. 

According to the observations and de- 
scriptions given by those who have had the 
best opportunities for becoming familiar 
with all its various phases, the symptoms 
attending its invasion and general course 
are too distinctly marked to be ever mista- 
ken for any other disease. In the minds of 
many who have been called to witness the 
developments of cholera, they undoubtedly 
exist with such distinctness and vividness 
as to render the most labored and accurate 
description tame. In this treatise, how- 
ever, a description of the leading and more 
prominent phenomena will be given, and so 
far as a general principle of practice is 
concerned, this might be very appropriately 
limited to its first or cold stage. 

The commencement of the disease is often 
so insidious as to pass unnoticed till the sys- 
tem is fully prepared for the sudden and vio- 
lent attack. The slight, painless diarrhoeea, 



58 ASIATIC CHOLERA. 

depression of the nervous power, and occa- 
sional vertigo may all pass unheeded, and 
the patient be apparently in perfect health. 
He may retire to rest entirely unconscious 
of approaching danger, and after enjoying 
a sound and undisturbed sleep for hours, be, 
on awakening from his slumbers, seized 
with a remarkable sickness, perhaps vomit- 
ing, accompanied with most remarkable and 
profuse discharges from the bowels. These 
inordinate evacuations are usually attended 
with severe pains, extending down the 
thighs, and a sense of complete and almost 
perfect exhaustion. The physical powers and 
vital energies are immediately prostrated. 
The temperature rapidly sinks below the 
normal standard — the body becomes be- 
numbed with an icy coldness — the skin be- 
comes shriveled up, and almost insensible 
to hot and stimulating fomentations — the 
breath, too, as it comes from the lungs, ap- 
pears to partake of the same icy coldness, 
indicating the rapid elimination of heat, or 
caloric, from the body. The patient com- 
plains of being greatly oppressed, throws 



PHENOMENA, OR SYMPTOMS. 59 

off his clothing — calls for cold water, which 
he eagerly and copiously drinks ; though it 
afford no relief to his insatiate thirst, it 
ought not to be withheld. This peculiar 
icy coldness and loss of temperature is also 
further shown by the livid, blue, or purple 
appearance of the hands and feet, extend- 
ing sometimes over the greater part of the 
body. The skin becomes, even in a few 
minutes after the seizure, not only shriv- 
eled up, but often curiously wrinkled, as 
in extreme old age. Severe spasms in the 
fingers, toes, legs, and abdomen, cause the 
patient to groan and writhe under their in- 
fluence, and to call on his attendants, if 
fortunate enough to have any around him, 
for aid and relief from his agonies. As the 
disease proceeds, there may be noticed a 
peculiar, sharp and contracted state of the 
features, and a wild and terrified expres- 
sion of the countenance, arising from the 
impression and fearful apprehension of rap- 
idly approaching dissolution. These im- 
portant changes may all take place in a 
very few minutes. To these most obvious 
6 



60 ASIATIC CHOLERA. 

and singular symptoms there is superadded 
constant vomiting — incessant purging — low, 
feeble pulse, though occasionally natural 
and sometimes rapid, yet in some instances, 
from the very first moment of attack, can- 
not be discovered either in the large super- 
ficial arteries or at the wrist. The voice is 
altered, becomes low, feeble, unnatural in 
tone, or sinks even to a whisper. Respira- 
tion becomes quick, irregular, laborious and 
imperfect. The inspiratory act being per- 
formed with difficulty, and expiration being 
quick and convulsive. The flow of bile into 
the intestines is suspended, the urinary se- 
cretion and micturation entirely suppressed. 
Almost the only organ which seems to pre- 
serve in any good degree its powers is the 
brain — the mental faculties in some cases 
being retained till the close of life ; — in 
other cases feeble, weak, and much impair- 
ed. On the accession of the spasms, the 
vomiting — and the purging — the disease 
may be considered as being fully developed, 
and the crisis at hand, which, in a few hours, 
must decide the fate of the patient. Its 



OR SYMPTOMS. 61 

progress is now rapid, and must speedily 
terminate either favorably or unfavorably. 
If the result be unfavorable, the patient 
may die with all these symptoms distinctly 
and strongly marked. If the termination, 
however, be favorable, these violent symp- 
toms soon yield, and seem to be materially 
relieved ; yet, though these indications favor 
the return of normal power — the weakness, 
the cessation of the pulse, the coldness and 
blueness of the surface, and the sepulchral 
expression of the countenance, clearly show 
that a few hours must close the scene. To 
many death thus often comes calmly and 
quietly, without any struggle to mark the 
precise time of this life's departure. 

" If the patient/ 7 says an eminent author, 
" should happily survive the cold stage, the 
disease may terminate by a rapid recovery, 
or it may pass into the second or febrile 
stage. The former is the more usual course 
in India, the latter in Europe. The first 
symptom of returning health is shown by 
the patient falling into a sleep of unusual 
soundness, during which the respiration be- 



62 ASIATIC CHOLERA. 

comes light and easy, the pulse freer, while 
a gentle, warm perspiration bedews the 
whole body. This grateful pause in the 
disease appears to be the result of the re- 
turning powers of life, uninfluenced by med- 
icine, for it often occurs where none has 
been given. After this balmy slumber the 
patient awakes refreshed, and often recovers 
so rapidly, that in the natives of India it 
almost resembles a restoration after syncope. 
In all the Presidencies, indeed, and espe- 
cially in Bengal, the recovery of the Euro- 
pean has, in general, been followed by a 
stage of reaction, usually slight, but in some 
cases assuming the form of the bilious re- 
mittent fever of the country, which has 
occasionally terminated fatally. In most 
cases, however, the reaction is more consid- 
erable, and the patient, in a few hours 
after the subsidence of the cold stage, labors 
under a severe form of fever, resembling 
the typhoid. During the first few hours 
after the febrile reaction commences the 
tongue is white, but it quickly becomes 
brown and dry, while black sordes incrust 



PHENOMENA, OR SYMPTOMS. 63 

the teeth and lips. The eye becomes deeply 
injected and red, the cheek pale or flushed, 
the pulse rapid, and the temperature of the 
body a little above the natural standard. 
The patient, either delirious or comatose, 
then lies in a state resembling the last stage 
of the severest typhoid fever of this coun- 
try. This struggle usually lasts from four 
to eight days, when the symptoms either 
gradually yield, or death ensues. In a few 
mild cases the fever assumes an intermittent 
type, or sometimes a quotidian, sometimes a 
tertian form : all these cases usually re- 
cover. Such is, in brief, a summary of the 
more important symptoms of the Epidemic, 
or Asiatic Cholera, especially in its earlier 
or cold stage. The phenomena, especially 
developed in, and belonging to, the stage of 
reaction, being of minor importance, they 
have received only a very brief considera- 
tion; sufficient, however, to show the general 
character and tendency of the disease in 
this stage of its progress and termination. 



6* 



CHAPTER III. 

Section I. — Unsuccessful Modes of 

TREATMENT — VENOUS TRANSFUSION EX- 
PLAINED. 

In this discussion we shall avail ourselves 
of the researches and investigations of emi- 
nent Professors, whose observations, expe- 
rience, and' position give their views the 
highest authority. The latest and most de- 
serving record on this subject is from the 
pen of Professor Aiken, of Edinburgh, who 
observes, " There are few diseases for the 
cure of which so many different remedies 
and modes of treatment have been employed 
as in Cholera, and, unfortunately, without 
our discovering an antidote to the poison. 
In Moscow it is said that the mortality was 
not greater among the destitute of medical 
aid than among those who had every care 
and attention shown them. It may be fairly 

(64) 



UNSUCCESSFUL MODES OF TREATMENT. 65 

inferred, therefore, that in the severer forms 
of the disease, the action of this poison is so 
potent as to render the constitution insensi- 
ble to the influence of our most powerful 
remedial agents. When, however, the dis- 
ease is mild, or on the decline, much may 
be done by obviating symptoms to promote 
the recovery of the patient." 

" The heroic remedies that have been em- 
ployed in Cholera are bleeding, and calo- 
mel and opium, either separately or con- 
jointly. With respect to bleeding, it may 
be stated, that in every country the patients 
bore bleeding badly in any stage, and that 
the practice in Europe was at length limited 
to a few leeches occasionally to the head. 
As to calomel, that medicine was used to the 
greater part of an ounce in the twenty-four 
hours, but with so little success that many 
patients have been seized and have died 
under the full influence of mercury. On 
the appearance of cholera in Europe, opium 
was administered in the doses recommended 
by the Indian practitioners to the greater 
part even of an ounce of laudanum ; but it 



66 ASIATIC CHOLERA. 

was soon seen that in the cold stage it was 
inefficient in controlling the vomiting or 
purging ; that it did not allay the spasms, 
and, moreover, hardly produced any nar- 
cotic effect. The action of the accumulated 
doses of opium, however, though suspended 
during the cold stage, was often fully devel- 
oped in the last stage, and occasioned so 
much affection of the head that most prac- 
titioners either abandoned its use or limited 
it to a mere fractional dose of that usually 
given in India, namely, from three to twelve 
minims of the tincture of opium, or half a 
grain to a grain of solid opium every four 
or six hours." 

Let us now turn to a paper by the justly 
celebrated Professor Maclean, whose obser- 
vations and experiences have been more ex- 
tensive than perhaps those of any other pro- 
fessional gentleman either in Europe or 
America. Unlike many of his brethren, he 
holds on this subject the safer doctrines of 
practice, and very frankly and earnestly 
expresses the same in the following lan- 
guage : " Opium in cholera should be given 



UNSUCCESSFUL MODES OF TREATMENT. 67 

only in the premonitory diarrhoea. At this 
stage, in combination with a stimulant, it is 
of the highest value. If persevered in, par- 
ticularly in the strong doses (justly repro-' 
bated), it is a dangerous remedy, inducing 
fatal narcotism, or, at the least, interfering 
with the functions of the kidneys, and so 
leading directly to ursemic poisoning. 27 

" Urgent thirst is one of the most distress- 
ing symptoms in cholera ; there is inces- 
sant craving for cold water, doubtless in- 
stinctive, to correct the inspissated condi- 
tion of the blood, due to the rapid escape of 
the liquor sanguinis. It was formerly the 
practice to withhold water — a practice as 
cruel as it is mischievous. Water in abund- 
ance, pure and cold, should be given to the 
patient, and he should be encouraged to 
drink it, even should a large portion of it 
be rejected by the stomach ; and when the 
purging has ceased, some may, with much 
advantage, be thrown into the bowel from 
time to time. 

In the stage of reaction, the fever may be 
moderated by cold sponging, or by the wet 



68 ASIATIC CHOLERA. 

sheet ; the secretion of urine may be promo- 
ted by dry cupping over the loins by the 
use of chlorate of potash, and the like. But 
'suppression of this secretion is most to be 
dreaded where opium has been too freely 
used in the treatment. In men of intemper- 
ate habits, we often see, during the stage of 
reaction, obstinate vomiting of thick, tena- 
cious, green, paint-looking matter, probably 
bile pigment, acted on by some acid in the 
stomach or alimentary canal. It is a symp- 
tom of evil omen, and often goes on uncon- 
trolled until the patient dies exhausted, and 
this although all other symptoms may prom- 
ise a favorable issue. I have known it 
last for a week, resisting all remedies, and 
proving fatal when the urinary secretion 
had been restored and all cerebral symp- 
toms had subsided. Alkalies in the effer- 
vescing form, free stimulation of the surface, 
and chloroform in small doses offer the best 
hope of relief. The patient should be nour- 
ished more by the bowel than the stomach 
when vomiting is present. Ice should be 
given ad libitum when it can be obtained, 



UNSUCCESSFUL MODES OF TREATMENT. 69 

not only to dissolve in the mouth, "but to 
swallow in pieces of convenient size.' 7 

" Another heroic plan/ 7 says Dr. Aiken, 
" peculiar, perhaps, to this country, which 
was practiced when the inefficiency of medi- 
cines was generally admitted, was an injec- 
tion of a solution of half an ounce of muri- 
ate of soda, and four scruples of sesquicar- 
bonate of soda in ten pints of water, of a 
temperature varying from 105 to 120 Pali., 
into the veins of the suffering pa- 
tient. The solution was injected slowly ; 
half an hour being spent in the gradual in- 
troducion of the ten pints, and the immedi- 
ate effects of this treatment were very strik- 
ing. The good effects were rapid in pro- 
portion to the heat of the solution,, but a 
higher temperature than what is stated 
could not be borne. After the introduction 
of a few ounces, the pulse, which had ceased 
to be felt at the wrist, became perceptible, 
and the heat of the body returned. By the 
time three or four pints had been injected 
the pulse was good, the cramps had ceased, 
the body, that could not be heated, had be- 



70 ASIATIC CHOLERA. 

come warm, and instead of cold exudation 
on the surface, there was a general moist- 
ure ; the voice, before hoarse and almost 
extinct, was now natural, the hollowness of 
the eye, the shrunken state of the features, 
the leaden hue of the face and body had dis- 
appeared, the expression had become ani- 
mated, the mind cheerful, the restlessness 
and uneasy feelings had vanished, the ver- 
tigo and noises of the ear, the sense of op- 
pression at the precordia had given way to 
comfortable feelings ; the thirst, however 
urgent before the operation, was assuaged, 
and the secretion of urine restored, though 
by no means constantly so. But these 
promising appearances were not lasting ; 
the vomiting continued, the evacuations be- 
came more profuse, and the patient soon 
relapsed into his former state, from which 
he might again be aroused by a repetition 
of the injections ; but the amendment was 
transient, and the fatal period not long de- 
ferred. Of 156 patients thus treated at 
Drummond Street Hospital, Edinburgh, 
under the direction of Dr. Macintosh, only 



UNSUCCESSFUL MODES OF TREATMENT. 71 

25 recovered ; a lamentably small propor- 
tion ; and, small as it is, it seems doubtful 
if the recoveries were final or complete. 77 

But let us turn to another page, whose 1 
beauty is especially marred by unreasonable 
expedients : a The warm bath, 77 says the* 
writer, "was at first tried, but discontinued, 
from the uncontrollable nature of the vomit- 
ing and purging, and the oppressive sensa- 
tion of heat it produced on the patient 7 s 
feelings. Mr. Dalton 7 s vapor bath and 
Turkish baths in the Hospital at Scutari 
have been used, but without benefit, and 
to the disappointment of the hopes which 
had been entertained of them. 77 

Other methods of restoring warmth were 
had recourse to, such as frictions with the 
hand or by the flesh-brush, or rubbing the 
body with some strong stimulant embroca- 
tion, compounded of garlic, capsicum, cam- 
phor, cantharides, or other powerful ir- 
ritants. Mustard poultices also were often 
applied to the feet and abdomen, blisters 
with or without an addition of oil of turpen- 
7 



72 ASIATIC CHOLERA. 

tine, the part having been previously rubbed 
with hot sand ; and in cases supposed to be 
urgent, the mineral acids, and even boiling 
water, were employed for the purpose of 
producing instant vesication.' 7 

" And, again, we read of those who tried 
to stimulate the waning powers of life by 
galvanism, acupuncture of the heart, issues, 
setons, moxas, actual cautery along the 
spine, and, lastly, by small pieces of linen 
dipped in alcohol distributed over the body 
and then set fire to ! ! ! " Such are some of 
the means which have been used in the 
treatment and cure of cholera. 

" The failure of such powerful means at 
length caused most practitioners to confine 
themselves to checking the diarrhoea, which 
so frequently precedes cholera, and subse- 
quently, to obviating symptoms as they 
arose,' 7 and for this purpose, returned to 
and adopted a very simple stimulating 
mixture, recommended by the Board of 
Health : 

5. Pulveris Aromat., . . . 3 iij. 
Tine. Catechu, .... •• x. 



UNSUCCESSFUL MODES OF TREATMENT. 73 

Tine. Cardamom, C, . * " vj. 

Tine. Opii, . . . • • " j. 

Mixt. Cretse Preparat., . . |xx. 

M. S., j 3 , as necessary. 

Tine. Kino, or the decoctum Hagmatoxyli, 
were sometimes added. 

These remedies, it is said, frequently ar- 
rested the attack altogether. If, however, 
the disease proceeded and the cold stage of 
cholera formed, the same remedies were 
prescribed in an effervescing draught. " To 
promote reaction in cholera and diarrhoea, 
the following formula has met with most 
universal approval in this country and in 
India. So highly is it valued, indeed, that 
it is ordered to be always in store, and in 
readiness in the Medical Field Companion 
of the army when on the march : " 
5.01. Anisi, " ) 

01. Cajeput, >- aa. 3SS. 

01. Juniper, ) 

JEther, |ss. 

Liquor Acid. Haleri* . . 3 ss. 

Tine. Cinnam., |ij. 

* Sulphuric acid, one part ; Rectified Spirit, three 
parts. 



74 ASIATIC CHOLERA. 

M. S.: ten drops every fifteen minutes, 

in a table-spoonful of water. An opiate 
may "be given with the first and second dose, 
"but should not be continued." 

The learned author to whom we have re- 
ferred, after detailing some of the various 
expedients employed in the treatment and 
cure of cholera, sums up the whole under 
the common term — failure — and, in effect, de- 
clares the most powerful remedial agents 
ineffective and useless in controlling and 
subduing this disease. 

This declaration is made in reference to 
the general result of the remedies and the 
various expedients adopted mainly by one 
class of physicians, to which special refer- 
ence has been made. It is therefore partial, 
and confined solely to what is erroneously 
termed the regular practice. In declar- 
ing all remedial agents a failure, does 
not the author himself commit a greater fail- 
ure in omitting to survey the whole subject 
of treatment, and to trace out and to show 
from the application of the pathology of the 
disease the probable cause of such failure ? 



UNSUCCESSFUL MODES OF TREATMENT. 75 

However formidable this disease may 
appear, on account of its rapidity and its 
firm, unyielding grasp upon the vital pow- 
ers, the forbidding and almost hopeless 
prospect of relief, and the lamentable re- 
sults which have attended some modes of 
treatment, it seems particularly unfortunate 
for the profession that there should have 
been a disposition on the part of this learn- 
ed author to abandon all remedial agents as 
comparatively useless, without a more thor- 
ough investigation into the cause of failure. 
On this point no effort or inquiry even is 
made. This is the more remarkable and sur- 
prising after dwelling at length on the path- 
ology of the disease. It would seem as if all 
the light and science derived from this source 
for nearly half a century had been over- 
looked, or the pathology of the disease, 
from some cause not satisfactorily explained, 
had been deemed unworthy at least in this 
instance to dictate the course of treat- 
ment. This should govern in cases of 
cholera as in all other forms of disease, or 
else all our efforts and remedies will prove 
7* 



76 ASIATIC CHOLERA. 

abortive. Now, had the doctor carefully 
investigated the various modes of treatment 
and compared the results of each, he might 
have come to a different conclusion. But, 
being confined and limited in his investiga- 
tions, he is unable to discover anything re- 
liable or worthy his commendation, except 
the formulas above and the recommenda- 
tion of Dr. Maclean. Among all the reme- 
dies and expedients named, there is only 
one tending to fulfil, the indications required, 
and that one, though prompt and magical 
in its effects, has been unequivocally con- 
demned, without looking beyond the tran- 
sient result for any light it might shed upon 
the subject. How it should have escaped 
his notice and passed so long unobserved 
by the numerous professional gentlemen 
who had often witnessed the effect, and 
were anxiously searching for light and the 
means of affording relief to the suffering 
patient, is a most singular circumstance 
which can only be accounted for on the 
principle that they all were anticipating 
some strange phenomenon, or development 



UNSUCCESSFUL MODES OF TREATMENT. 77 

of cure as mysterious as the disease itself, 
which led them to overlook the simple 
and effective means of relief so clearly rep- 
resented and shown in their numerous ex- 
periments for something more heroic and 
powerful than as yet the imagination ever 
conceived. 

If we trace the action of calomel, the 
use of opium, the effect of cupping, bleed- 
ing, blistering, etc., etc., we shall obtain no 
very desirable information ; nothing valu- 
able tending to indicate a correct principle 
of practice. If we go still further, and 
examine the tendency and effects of the 
various baths exhibited at Scutari, the use 
of the flesh-brush, the bare hand, the heated 
sand, the embrocations, the turpentine and 
other irritants, the boiling water, or the 
burning alcohol, skinning and cooking the 
patient alive, we shall be shocked at the 
enormous cruelty and barbarity that have 
been pursued, and turn from the repulsive 
exhibition, without discovering one ray of 
light to guide us in the right direction. 
Disappointed and baffled in our inquiries, 



78 ASIATIC CHOLERA. 

shall we here abandon oar investigations 
and dismiss the whole subject, because our 
course is involved in difficulties? Would 
intelligence and reason justify the neglect 
to improve the means at command? We 
think not ; but rather induce us to advance 
in search of truth if the elements of success 
are not quite exhausted. Let us be en- 
couraged and stimulated to untiring per- 
severance so long as there remains any 
experiment untraced and uninvestigated in 
its bearing upon the direct action of the 
disease. Had Dr. Aiken, or those other 
eminent surgeons who took part in those 
numberless experiments, instituted on the 
Continent and in England, especially those 
who initiated the process of injecting into 
the veins a solution of soda raised to a 
temperature from 105° to 120° Fahr., con- 
tinued their investigations patiently and 
assiduously, they might probably have dis- 
covered long ago the correct theory of 
practice for the treatment and cure of 
cholera. 

But they failed to see, or, if they saw at 



UNSUCCESSFUL MODES OF TREATMENT. 79 

all, rejected the feeble ray of light struck 
out by the experiments in which they had 
themselves participated, and like the cele- 
brated Dr. Hunter, who refused to listen to 
the discoveries made by his pupil, the in- 
defatigable Jenner, who traced the identity 
of the variola with the common disease 
affecting the kine ; and thence extracted 
the vaccine lymph and established a prin- 
ciple by which that loathsome disease and 
often recurring epidemic has been nearly 
banished from the earth. Though they 
have thus failed, they have nevertheless 
left on record, in unmistakable language, 
the result of their bold experiments, which 
we may investigate, and appropriate the 
instruction drawn thence for our own and 
the advantage of our fellow-men. 

What, then, are these results, regarded as 
shedding light on this intricate subject? 
We refer only to one the most obvious 
which we have already cited above. Let 
us repeat and analyze, and, if practicable, 
show the principle evolved. There was, 
on various occasions, the solution of soda 



SO ASIATIC CHOLERA. 

injected into the veins at tlie temperature 
from 105° to 120° Fahr. : a higher tem- 
perature could not be borne. This process 
was performed slowly, thirty minutes being 
occupied in injecting the ten pints. Now 
mark the result as the operation proceeds. 
Says Dr. Aiken, " After the introduction of 
a few ounces, the pulse, which had ceased 
to be felt at the wrist, became perceptible, 
and the heat of the body returned." Mark 
the language : " only a few ounces" were re- 
quired to arrest for the time being, the prog- 
ress of the disease and restore warmth to 
the body ; a very remarkable fact, replete 
with instruction, as will appear as we 
proceed. Again says the Dr., " by the time 
three or four pints had been injected the 
pulse was good, the cramps had ceased, the 
body, that could not be heated, had become 
warm, and instead of cold exudation on the 
surface, there was a general moisture. The 
voice, before hoarse and almost extinct, was 
now natural ; the hollowness of the eye, 
the shrunken state of the features, the 
leaden hue of the face and body had dis- 



UNSUCCESSFUL MODES OF TREATMENT. 81 

appeared ; the expression liad become ani- 
mated, the mind cheerful, the restlessness 
and uneasy feelings had vanished ; the ver- 
tigo and noises of the ear, the sense of 
oppression at the precordia. had given way 
to comfortable feelings ; the thirst, how- 
ever urgent before the operation, was 
assuaged, and the secretion of urine re- 
stored, though by no means constantly so. 77 
Such is the astonishing result obtained by 
this experiment, and this, too, when only 
three or four ounces had been injected — all 
the urgent symptoms mitigated and re- 
lieved. What, we ask, could have been 
more satisfactory, or better calculated to 
aid the discovery of an important truth? 
Every distinctive and fatal symptom for 
the time is relieved, and the normal con- 
dition and functions of the system restored ; 
a result which could only have been ob- 
tained by the evolution of a principle of 
sufficient promptness and power and diffusi- 
bility to arrest and utterly suspend for a 
time the force of this disease. 

What, then, was the principle evolved in 



82 ASIATIC CHOLERA. 

this experiment, which gave immediate 
relief? Did it consist in the half ounce of 
muriate of soda alone, or in the four scruples 
of scsquicarbonate of soda, alone, or in the 
ten pints of water alone, or in the whole 
combined, or more especially in the high 
temperature to which the solution was 
raised ? It is a well-established fact that, 
in order to raise the temperature of cold 
water to blood heat and above, a large 
amount of free caloric must necessarily be 
absorbed, and exist mechanically in the 
fluid ; and, in this condition, the solution 
was introduced into the veins, and there 
evolved its vast amount of free caloric, 
which immediately permeated every organ 
of the system, arresting disease, raising the 
temperature of the body, and restoring its 
normal functions. Of this there can be 
little doubt. For free caloric is one of the 
most prompt, effective and diffusive stimu- 
lants known, and was evidently in this case 
the remedial agent which produced the 
result. True, it may be said the effect was 
transitory, and passed off as soon as the 



UNSUCCESSFUL MODES OF TREATMENT. 83 

caloric became eliminated. This, however, 
cannot alter the nature, character, or in- 
fluence of the principle on which it was 
produced. It is usually admitted that a 
remedy that has power to control disease, 
will, by its continued action and influence, 
restore the normal condition of the system 
permanently, or at least aid Nature to repair 
her own work. By this we .would not be 
understood as advising a repetition of the 
experiment under consideration, even under 
the most urgent circumstances ; far other- 
wise would be our advice. We are arguing 
for the purpose of evolving and establish- 
ing a general principle of practice. 

The great question, then, is, Did the prin- 
ciple evolved fulfill the indications required ? 
and if so, is it available and consistent with 
the pathology and the peculiar phenomena, 
or symptoms of the disease? To settle 
this point, we need only turn to the law 
and the testimony, the very highest author- 
ity on the subject. The doctrine now uni- 
versally accepted and prevailing regarding 
its pathology is, that a poison, virulent, and 
8 



84 ASIATIC CHOLERA. 

subtle, and unknown, has been absorbed and 
infects the blood, so that after a longer or 
shorter time, a primary disease of this vital 
fluid is produced, by "which the vital energy 
is impaired, and all other morbific changes 
induced. The term " Algide," first used by 
the French Pathologists, very accurately 
describes one of the most remarkable 
and constant symptoms, viz., the diminu- 
tion of animal heat. On this depend the 
altered condition of the blood, the depres- 
sion of the nervous power, the impaired 
functions of the respiratory and all the 
vital organs which are essentially involved 
by the disease. The icy coldness of the 
surface, the breath, the extremities and 
general loss of temperature, all show the 
character of the disease and the wants of 
the system. 

Did, then, the principle evolved accord 
with the pathology and phenomena of dis- 
ease ? And did it fulfill the indications re- 
quired? If not, we ask by what means 
was the disease arrested, and all the urgent 
symptoms mitigated and relieved, or by 



UNSUCCESSFUL MODES OF TREATMENT. 85 

what were the good effects produced, and 
the normal action for a time restored ? 
Can the result be reasonably accounted for 
on any other principle than the one as- 
signed—the stimulating power of the free 
caloric ? We think not ; for it accords 
most perfectly with the pathology and the 
peculiar phenomena of the disease. It as- 
suaged the more urgent symptoms, answered 
the imperious demand of the waning powers, 
revivified and reinvigorated the vital ener- 
gies, and restored for the time the normal 
tone of the system. What more could be 
desired in any single agent than the result 
here obtained ? That it accomplished all 
this, there can be no question, according to 
the statement of the learned professors who 
have repeatedly witnessed and described the 
results. 

The question, however, will arise, Can 
this principle be rendered available ? Most 
certainly it can ; and though it may not be 
convenient to introduce free caloric into the 
stomach, we can, by combination, introduce 
a stimulant of equal potency which shall be 



86 ASIATIC CHOLERA. 

equally as prompt, effective and diffusive in 
its action, similar in its influence, and simi- 
lar in its results. It is the principle — not 
the precise element for which we contend. 

It is universally admitted that in many in- 
stances we may learn much from observing 
the manner of death which, in a majority of 
th^c cases of cholera, may be described by 
the term asthenia — a death similar to that 
which occurs in congestive fevers, and in 
some cases of accidental poisoning. Per- 
haps the most striking fact observed in 
these cases is the perfect exhaustion attend- 
ing the last moments of existence, and the 
quiet, undisturbed manner in which life 
terminates. This very clearly shows the 
exhausting nature and congestive character 
of the disease, and gives us an idea of the 
course of treatment necessary to be pur- 
sued. If, then, there is anything to be 
learned from this source relative to its 
treatment, it does most certainly corrobo- 
rate and strengthen the position we have 
here taken. 

Another feature of the case in aid of our 



UNSUCCESSFUL MODES OF TREATMENT. 87 

position consists in its entire accordance 
with the modes of treatment which have 
been most successful in the qure of cholera. 
The two formulas cited above, and now 
most universally adopted in Europe and 
India, are based on a similar principle. So 
in this country 1832,-33 and 34, the suc- 
cessful modes of treatment consisted in the 
adoption of a principle essentially similar. 
Hence we infer from the teachings of this 
experiment, and from all the collateral facts 
on the subject, that the general principle to 
be observed in the treatment of this dis- 
ease is a prompt and diffusive stimulant ; 
and hence we deduce the doctrine already 
apparent, that every form of treatment, to 
be successful, must be based on a prompt and 
effective stimulant of sufficient power to 
meet as speedily the indications required, 
as did the free caloric in the experiment to 
which we have referred. 

Here we might pause for a moment and 
examine the suggestion and doctrines ad- 
vanced by the learned Drs. Bell, Johnson, 
and many other eminent practitioners in 



88 ASIATIC CHOLERA. 

India and Europe. We might further in- 
vestigate the principles and trace the prac- 
tical philosophy of such eminent surgeon, 
as Drs. Mackintosh, Thompson, Wallis 
Maxwell, Massy, Hill and Brady, all of 
whom have had opportunity of investiga- 
ting the nature and character of the dis- 
ease and extensive experience in its treat- 
ment. 

We might also, in a further examination 
of the subject, embrace a host of American 
authors whose works teem with every shade 
of doctrine, and almost every variety and 
description of practice, some evincing a de- 
gree of skepticism on the subject more won- 
derful and marvelous than is becoming the 
great apostles of medicine. It would seem 
as if the guiding light of science and expe- 
rience had forsaken them in this, the hour 
of their need ; that facts and arguments 
had failed to illumine their minds, or direct 
their inquiries in the proper course for the 
discovery of " the truth. 77 Their conclu- 
sions on this subject are, therefore, marvel- 
ously inconsistent and conflicting. Over 



UNSUCCESSFUL MODES OF TREATMENT. 89 

this mass of specious and conflicting testi- 
mony we might long ponder, without de- 
riving any very valuable information wor- 
thy an elaborate effort, or making any dis- 
covery to aid in the establishment of a gen- 
eral principle of practice for the cure of 
cholera. But this investigation must be 
deferred to another occasion, when time 
may permit a more thorough and critical 
examination of their doctrines and practice 
than can be presented in this brief essay. 
We would, however, remark in passing, 
that in some instances their philosophy, 
doctrines, and results may lead us to the 
same conclusion to which we have arrived 
from other sources as above, and from our 
regard and belief in the progress of sci- 
ence, feel compelled to advocate the same, 
as offering the best hope of success in the 
treatment of this disease. 

In the employment of an anti-miasmatic 
principle and remedial agent, we feel our- 
selves abundantly sustained, by the concur- 
rent testimony, of those English surgeons 
connected with the Medical Bureau in the de- 



90 ASIATIC CHOLERA. 

partmnet of India, whose numerous experi- 
ments and carefully detailed clinic cases oc- 
curring in the recent irruption and preva- 
lence of the disease in that section, exhibit its 
utility in such a striking contrast with all for- 
mer practice, as to leave no doubt as to its 
direct and specific action in the cure of chol- 
era. It is in allusion to these experiments, 
and in answer to the question, what is 
deemed the most successful mode of treat- 
ment, that the learned Professor Maclean 
unhesitatingly observes, "Alkalies in the 
effervescing form, free stimulation of the 
surface, and chloroform in small doses, offer 
the best hope of relief." As this opinion 
comes from such high authority, and is com- 
patible with the pathology of the disease, 
we may, without fear of controversy, add 
in conclusion, in any and every form of med- 
ication for the cure of cholera, we must not 
forget that chloroform is our sheet-anchor ; 
and must be so combined and administered 
as to meet promptly the indications re- 
quired. 



THE BLOOD. 91 



Section II. — Physiological Condition of 
the Blood. 

its non-aeration — non-oxydation. 

In the preceding section we alluded to 
the suggestions and doctrines advanced by 
the learned Dr. C. W.Bell, Physician to the 
Manchester Infirmary, and late Physician 
to H. M. Embassy in Persia — and also to Dr. 
George Johnson, of Kings College, whose 
views and doctrines, relative to the Patholo- 
gy, illustrative of the congestive character 
and non-aeration of the blood, coincide with 
those of Dr. Bell. A brief examination of 
their philosophy and doctrines will show 
very conclusively the first direct impression 
of the poison — the gradually altered condi- 
tion of the blood, and the corresponding 
loss of nerve power — the impeded arterial 
circulation and the general tendency to 
congestion, as well as the altered condition 
and stagnation of the blood, especially dur- 
ing the stage of collapse. 



92 ASIATIC CHOLERA. 

The question is asked. " What is the 
pathological explanation of this remarkable 
train of symptoms ? " and the answer is 
given, " The one great central fact is this, 
that during the stage of collapse, the pas- 
sage of blood through the lungs, from the 
right to the left side of the heart, is in a 
greater or less degree impeded." Very 
conclusive evidence as to the existence of 
impeded pulmonary circulation during life 
is afforded by the appearances observed in 
the heart, blood-vessels, and lungs after 
death. 

After adducing the evidence of this im- 
pediment from post-mortem examinations, 
and affirming that the blood does not flow 
freely through the lungs and pulmonary 
arteries, which are often filled and much 
distended with blood, it is observed — " The 
most interesting and conclusive evidence 
that arrest of blood in the lungs is the true 
key to the pathology of choleraic collapse, 
is to be found in the simple yet complete 
explanation which it affords of all the most 
striking chemical phenomena of the disease, 



THE BLOOD. 93 

the imperfect aeration of the blood, and the 
suppression of bile and urine." 

And again, says the learned author, " It 
is obvious that the stream of blood from the 
pulmonary capillaries to the left side of the 
heart is the channel by which the supply of 
oxygen is introduced into the system. One 
necessary consequence, then, of a great dim- 
inution in the volume of blood transmitted 
to the left side of the heart must be, that 
the supply of oxygen is lessened in a corre- 
sponding degree. This position, probably, 
will not be disputed by any one who will 
give the subject a moment's consideration. 
Nor, again, can it be denied or doubted 
that certain results must of necessity follow 
this limited supply of oxygen.' 7 * * * 

" The blood in cholera is black and thick 
only during the stage of collapse ; in other 
words, during the stage of pulmonary ob- 
struction and defective aeration." 

Again, in his explanation of the injection 
of the solution of soda into the veins of the 
suffering patient, it is affirmed, " The benefit, 
however, is of but short duration, for the 



94 ASIATIC CHOLERA. 

primary cause of the impeded circulation, 
namely, the poisoned condition of the blood, 
being still in operation, * * * the stream 
of blood through the lungs will soon again 
be obstructed, and the patient thus passes 
into a state of collapse as profound as, and 
more hopeless than, before. It appears, 
therefore, that the hot saline injection into 
the veins and the operation of venesection, 
when it rapidly relieves, as it often has 
done, the symptoms of collapse, have this 
effect in common, that they facilitate the 
passage of the blood through the lungs, and 
thus lessen that embarrassment of the pul- 
monary circulation which is the essential 
cause of choleraic collapse. But whereas 
the hot injections act by removing the im- 
pediment which results from spasmodic con- 
traction of the arteries ; venesection acts by 
relieving over-distension of the right cavi- 
ties of the heart, and thus increasing the 
contractile power of their walls. " 

Such are, in brief, the views of the learned 
Drs. Johnson and Bell, whose works are 
very highly commended by their American 



CONDITION OP THE BLOOD. 95 

editor to the notice of the profession. These 
views, coming as they do from the highest 
authority, fully sustain the doctrine that the 
earliest impression of the disease is made 
upon the blood, and hence it becomes altered 
and changed in its most essential life-sus- 
taining principle ; for its oxygen becomes 
diminished, its consistency augmented, and 
its flow through the lungs impeded. 
Through this channel the effect of the 
poison soon makes an impression on the 
ganglionic mechanism, and the nerve-power 
becomes correspondingly diminished, and 
the action of the ganglionic nerves essen- 
tially deranged. But this is not all : they 
exhibit in the clearest manner the conges- 
tive character of the disease, and show the 
necessity of prompt and decided means to 
arrest this tendency. Hence, they urge, in 
the strongest terms, the importance of ob- 
serving carefully this essential feature, and 
endeavor to exhibit fully the condition of 
this vital fluid at a particular stage of the 
disease, when bleeding, as recommended in 
their practice, is required, and may be per- 
9 



96 ASIATIC CHOLERA. 

formed to the best advantage for the relief 
of the partially congested blood-vessels, and 
to stimulate and give freedom to the circu- 
lation. The passage of the blood, they 
affirm, is impeded, clogged, and partially 
suspended. To remove this obstruction, re- 
lieve spasm, and secure the prompt aeration 
of the blood, in hope of arresting the prog- 
ress of this disease, is ostensibly the ob- 
ject. However, they seem studiously to 
avoid the most logical conclusions of their 
explanations, and justify a practice that can 
give no hope of permanent relief, while 
every fact and symptom is ominously sug- 
gestive of the wants of the system, which 
imperiously demands the aid of electrified 
oxygen, ozone, or free caloric, for the oxy- ' 
dation of the blood. 

Says Dr. Reid, " I believe the true expla- 
nation of the arrest of blood in the lungs to 
be this : The blood contains a poison, whose 
irritant action upon the muscular tissue is 
shown by the painful cramps which it occa- 
sions. The blood thus poisoned excites 
contraction of the muscular walls of the 



CONDITION OF THE BLOOD. 97 

minute pulmonary arteries, the effect of 
which is to diminish, and, in fatal cases, en- 
tirely to arrest the flow of blood through 
the lungs." 

Says Dr. Wallis, " The phenomena which 
are exhibited when the deleterious air has 
been drawn into the lungs are these : the 
great gastro-pulmonary nerve is either 
wholly or partially paralyzed ; the conse- 
quences are the cessation of all its functions, 
either wholly or partially. This great nerve 
is a nerve of function, and performs the 
functions of digestion and respiration, and 
influences all secretions." 

Dr. Maxwell, of Calcutta, uses the fol-* 
lowing language : " The development of the 
stages of fever entirely depends on the 
changes the leaven has effected. If this change 
has been such that the blood has become too 
thick to flow through the lungs, then, as a 
matter of course, the collapse stage is de- 
veloped in excess ; in other words, cholera 
asphyxia is exhibited. The blood, unable 
to pass through the middle passage into the 
arteries, collects and swells out the veins, 



98 ASIATIC CHOLERA. 

giving that deadly or blue color to the skin. 
When the vomiting and spasms come on, 
this mass of blood in the veins is squeezed 
with great force, and hence the clammy 
moisture that is forced from every part dur- 
ing these fits. There is no pulse, because 
there is no blood in the arteries. ?; " There 
are also lethargy and languor, and oppres- 
sion in breathing, caused by the blood being 
collected in the veins. These make up the 
principal links in the chain of mechanical 
symptoms. 77 

Dr. Bell, dwelling on this congestive char- 
acter of the blood, and endeavoring tct point 
out the best mode of relief, observes, " When 
this has reached to such a point as to op- 
press the action of the heart, yawning first 
and then shivering, or a sense of suffocation 
and pain in the precordia, are the indica- 
tions of oppressed circulation, and of the 
commencing effort of the heart to overcome 
the mass of blood which is stifling it. If, by 
the application of tourniquets to the limbs, 
or by bleeding, part of the blood which is 
rushing from the extremities to increase 



CONDITION OF THE BLOOD. 99 

this congestion is prevented from reaching 
the great veins, the heart, excited to in- 
creased action, is enabled, by this relief? 
more quickly to overcome the obstruction 
and restore the balance of the circulation, 
and the paroxysm passes off. If not thus 
mechanically aided, the heart, after a severe 
struggle to maintain the circulation during 
the period of constriction, is at length re- 
lieved by this nervous disturbance or spasm 
of the capillary circulation passing off of it- 
self, and then the heart and arteries, so long 
excited by the struggle, maintain for a time 
their increased action after the obstruction 
in the capillaries is removed, and produce 
apparent febrile action. Presently this ex- 
citement subsides, the vessels become re- 
laxed, and sweat succeeds. The vessels 
continue in this state for a longer or shorter 
period, according to circumstances, till they 
at length recover their ordinary tone and 
action in the intermission. This fever, how- 
ever, is not fever properly so called, but re- 
action ; and the sweating not critical, or 
essential, but relaxation. The cold stage 
9* 



100 ASIATIC CHOLERA. 

is alone essential, and is the physiological 
cause of the subsequent stages." 

From the passages we have cited, it is 
quite evident that Drs. Johnson, Bell, 
Parkes, Reicl, Wallis, Maxwell, Massy, and 
many others, admit this congestive character 
and impeded circulation of the "blood to be 
the result, or consequent of a primary 
affection of the blood, as we have already ob- 
served in a former paper. The term " Al- 
gide" is peculiarly expressive of the dimin- 
ished animal heat, and, as Dr. Bell repre- 
sents, it is the cold stage which is alone es- 
sential, and is the physiological cause of the 
subsequent stages. It is the specific disease- 
poison, so often referred to, that has been 
inhaled, the leaven that has effected such ob- 
vious changes in the blood. The poison, vir- 
ulent, and subtle, and unknown, so marvel- 
ously active in its operations, that is exhib- 
ited so prominently in all the works we 
have perused as the one great, mysterious, 
and efficient cause which produces the dis- 
ease called cholera, and all the phenomena 
of its development. To its direct and spe- 



CONDITION OF THE BLOOD. 101 

cific action, therefore, must be attributed all 
the phenomena of the disease as the result- 
ing subsequent consequences. 

It is also further evident, from the patho- 
logical facts and arguments adduced in sup- 
port of this theory of congestion, that the 
abnormal condition or state of the blood- 
vessels is the result and the product of the 
activity of the primary or final cause, and 
must be regarded in relation to it as cause 
and effect. On this principle alone, the 
thickening of the blood, the contraction of 
the left ventricle of the heart, and of the 
capillary and pulmonary arteries, assigned 
by some as the cause of choleraic collapse, 
must be accounted for. These effects are 
not and cannot be from a process independ- 
ent and outside of the primary disease 
action, but are the result of such primary 
action. 

Again, it is evident, from the views and 
doctrines cited above, that the disease is 
decidedly congestive in its tendency and 
character from its very commencement. 
The impeded flow of the blood — the com- 



102 ASIATIC CHOLERA. 

parative emptiness of the left ventricle of 
the heart and arteries — and the excessive 
loss of temperature, all indicate a rapid 
process of congestion attending the prog- 
ress of disease. This is one of the peculiar 
and prominent features of cholera, and is 
strikingly exhibited in the morbid appear- 
ances observed in all those instances where 
death has occurred within a few minutes 
from the first indications of attack. 

When the attack is violent, the process 
is rapid ; when mild, it is slow ; and even 
in the collapse stage progresses tardily. 
In either case it is the direct resulting con- 
sequent of the primary cause. How else 
can the violent attacks, suddenly termina- 
ting in death, be accounted for ? To what 
other principle can this altered condition 
and stagnation of the blood be attributed ? 
The evidence confirmatory of this position 
is abundant and conclusive. Many in- 
stances of the apparently rapid action of 
the cholera poison are related by Dr. Mil- 
roy, in a historical sketch of the epidemic 
of 1817 ; and at Kurrachee in 1855 and 6, 



CONDITION OF THE BLOOD. 103 

it is said, that within little more than five 
minutes, hale and hearty men are seized, 
cramped, collapsed, and dead ! ! 

When the disease broke out at Teheran, 
in May, 1846, Dr. Milroy states that those 
who were attacked dropped suddenly down 
in a state of lethargy, and at the end of 
two or three hours expired, without any 
convulsions or vomitings, but from a com- 
plete stagnation of the blood. 

In the paper before us, it is stated, that 
"in a great majority of cases in which 
death has occurred during the stage of col- 
lapse, the right side of the heart and the 
pulmonary arteries are filled, and some- 
times distended with blood ; the auricle 
being partially, and the ventricle complete- 
ly and firmly contracted. The tissue of 
the lungs is, in most cases, of pale color, 
dense in texture, and contains less than the 
usual amount of blood and air. There is 
something surprising in the contrast be- 
tween the almost constant occurrence of 
this extremely ansemic condition of the 
lung, from which scarcely even a few drops 



104 ASIATIC CHOLERA. 

of blood flow when the tissue is cut, and the 
hyperemia of most of the other viscera." 
This impeded flow of the blood through the 
lungs, resulting, as it must, in a very scanty 
supply of blood to the arteries, in connec- 
tion with the corresponding fact of the in- 
creased expansion of the veins, filled with 
black, and thick, and stagnant blood which, 
by the action of a powerful poison, or ma- 
lignant disease, has become disorganized 
and unfitted for circulation, furnishes indu- 
bitable evidence of one prominent and char- 
acteristic feature of cholera which we term 
congestion, and to which we alluded in our 
remarks when the question under consider- 
ation was first introduced ; in this view 
we are happy to find ourselves, on a more 
thorough examination of the subject, ably 
sustained by eminent pathologists and au- 
thors, who have arisen during the half cen- 
tury last past, and whose works are said to 
embrace all that is known and reliable on 
the character and treatment of Epidemic 
Cholera. 
It is worthy of notice, before passing 



CONDITION OF THE BLOOD. 105 

from this part of our subject, that accord- 
ing to Dr. Bell's views, the blood is forci- 
bly scut into the great central veins, and 
there stopped in its course without any at- 
tempt to account satisfactorily for its singular 
arrest, at that point — Dr. Johnson comes to 
hjs relief, lifts the veil, and explains why it 
is kept there and cannot get any further. 
If the road, he tells us, had been clear and 
uninterrupted through the lungs, the blood 
would easily have got round to the left 
ventricle, and have again gone its round, 
but it is stopped by the spasmodic contrac- 
tion of the minute branches of the pulmo- 
nary artery, which will not even allow the 
blood to enter the pulmonary capillaries, as 
shown by the remarkable anaemia of the 
texture of the lungs. 

In this connection may be introduced an 
opinion as to the cause of the disease and 
some of its phenomena, which has obtained 
at least some celebrity, and attracted the 
attention, if not the careful consideration 
of the profession. It will account, in part, 
if founded in fact, for the physiological con- 
dition under consideration. 



106 ASIATIC CHOLERA, 

It is said, some have observed a chemical 
change in the constitution of the atmos- 
phere, and have attributed the cause of the 
cholera to the loss or diminution of its 
ozone — a principle which is understood to 
represent what is very properly termed 
electrified oxygen. Ozone is, therefore, the 
vital element of the air. It is said that 
oxygen cannot be assimilated or combined 
with the blood except when it is in an elec- 
trified state constituting the peculiar prop- 
erty or state of ozone. In this state it 
produces vital electricity of the blood, 
which is the life. The brain is considered 
and represented as the reservoir of this 
vital electricity, and the nerves are the tel- 
egraphic wires or conductors of it. As a 
necessary consequence, all acts of material 
and intellectual life depend upon this double 
cause. The absence, then, it is affirmed, of 
this principle, termed ozone — or electrified 
oxygen — from the atmospheric air in cer- 
tain localities and the consequent non-aera- 
tion or non-oxydation of the blood, may be 
•considered as an efficient cause which will 



CONDITION OF THE BLOOD. 107 

account for some of the most striking phe- 
nomena of the cholera. 

Whether this electrified oxygen, or ozone,, 
is identical with free caloric, it is unneces- 
sary for our purpose at present to determine.. 
It will be admitted that oxygen is the source' 
of animal heat, and when introduced into' 
the system generates its free caloric, which, 
is an essential life-sustaining principle. 

Dr. Massy, after describing a severe and' 
advanced stage of cholera, observes, " The 
treatment of this case depends in the first 
instance on bleeding, and largely, if the pa- 
tient's pulse is good, giving at the same time 
twenty grains of calomel with one of opium.. 
This, he thinks, will be found the best prac- 
tice. After twenty minutes, he gives ten 
grains more of calomel and half a grain of" 
opium. He considers, however, a reliance 1 
on opium in this form of cholera most 
faulty— but observes, as you draw blood,, 
stimulate, give punch, brandy, or wine and> 
water, or carbonate of ammonia. Apply 
friction, with stimulating and hot liniments 
to the extremities, warm sand-bags to the 
10 



108 ASIATIC CHOLERA. 

feet, sinapisms to the calves of the legs 
and pit of the stomach ; for, if you can once 
raise the pulse, the chances in favor of re- 
covery will be vastly increased." The 
practice of bleeding and stimulating at the 
same time is deemed of vast importance. 
Dr. Bell coincides in this view, and devotes 
much space to the necessary instruction as 
to the time when and under what circum- 
stances to bleed and to what extent, endeav- 
oring to show the advantages arising from 
a strict observance of certain rules in car- 
rying out this practice. 

We have thus traced, in extenso, the 
views and doctrines of eminent surgeons 
and authors on the changes of the blood, 
and especially of the impeded circulation, 
to show, if practicable, the inconsistency 
of the more common and prevailing prac- 
tice, and its utter inadaptation to the pa- 
thology and phenomena of disease. On the 
latter there seems to be little or no dis- 
crepancy — on the former there is a great 
diversity — as there has been no general prin- 
ciple established and laid down as the basis 



CONDITION OF THE BLOOD. 109 

of treatment and cure of cholera. It has 
often been observed there is no disease on 
which so many different modes of practice 
have prevailed, some purely experimental, 
others empirical — and all without discov- 
ering an antidote to the poison, or any effi- 
cient mode of relief. The cause, or the poison 
producing the disease, still remains un- 
discovered. The direct mode of suspend- 
ing and removing it, or counteracting its 
power and neutralizing its effect, and 
subsequently eliminating it from the 
system, remains still in doubt. What 
course, then, should the epidemic cholera 
again prevail in our midst, shall we pursue ? 
Shall we rest satisfied with the diversified 
modes of treatment now prevailing? Or 
guided by the light of reason, science and 
experience, endeavor to adopt a general 
principle of practice, and exhibit and es- 
tablish an efficient and judicious system, 
consistent with the pathology and the phe- 
nomena of the disease ? Does then the prac- 
tice, the prominent features of which are 
given above, accord with the indications re- 



110 ASIATIC CHOLERA. 

quired? In short, does the exhibition of 
bleeding and calomel and opium, accompa- 
nied with sinipisms, and hot, stimulating ap- 
plications to the surface, meet the patholog- 
ical condition and the phenomena of the dis- 
ease ? We have seen that the rapid chan- 
ges in the blood, and the consequent direct 
tendency to congestion, are the proper and 
distinguishing features of the disease ; — and 
hence the diminution of animal heat and 
general loss of temperature and their con- 
sequent effect, impeding the circulation, de- 
pressing and prostrating the nervous power 
— impairing and paralyzing the respiratory 
organs — suspending the functions of the 
liver and kidneys — enfeebling the action of 
the heart, and causing the capillary vessels 
of the mucous surfaces to pour off the 
serous fluid from the blood, and every mus- 
cle and tissue of the system with great ra- 
pidity, essentially constitute the phenomena 
of the cholera ; — and that the constantly 
increasing augmentation of the poison and 
its intensified effects, measure the malignity, 
the violence, and the rapidity of the disease. 



CONDITION OF THE BLOOD. Ill 

Is there, then, any tendency in bleeding to 
arrest this rapid process of disease so dis- 
organizing, depreciating, and enfeebling to 
the vital life-sustaining fluid, the blood? 
Can abstracting a portion of it, however 
large, suspend the poison, or its activity, or 
even check its progress in its rapid course 
and fatal termination? Can it have, under 
its depressing and depleting process, any 
tendency or power to relieve the congestion 
that is taking place, or change in any good 
degree the poisonous principle which is 
now generally admitted to exist in the 
blood, and to be the sole and efficient cause 
of its altered character and condition ? The 
poison, once introduced into the blood, like 
the leaven hid in three measures of meal, 
will continue its activity, increasing its en- 
ergy, and multiplying its forces, till the 
whole circulation becomes affected, and its 
life-sustaining power is destroyed and ut- 
terly lost, unless, by the exhibition of some 
remedial agent, it shall be promptly arrest- 
ed in its progress, and suspended and elim- 
inated. Again we ask, Will calomel fulfilL 
10* 



112 ASIATIC CHOLERA. 

any of the indications required? Has it 
any influence or power to arrest this dis- 
ease, to quiet the nervous system, relieve 
the cramps, or restore warmth to the body? 
Its specific action, so far as known, can 
have no tendency whatever to relieve the 
system in any essential particular, or stay 
the progress of disease, or delay its inevi- 
table result, if it remainun subdued by the 
action of other remedies. Its action upon 
the liver, however prompt it may be, is only 
of a secondary importance. The primary 
cause must be overcome, its activity and 
energy suspended and the system generally 
relieved, or there is little hope in the case. 
Here we may ask, Will opium aid, or 
give the relief so urgently demanded? 
However serviceable as an astringent and 
anodyne in the premonitory stage of the 
disease, it cannot be exhibited in the second 
stage to so good an advantage, as its direct 
influence is to aid and promote congestion 
in those cases, where a tendency of this 
kind is already in existence. Hence, its 
continuance in the true or collapse stage 



CONDITION OF THE BLOOD. 113 

of cholera is now generally considered 
faulty. 

Once more : The auxiliaries employed 
in aid of the leading remedies already 
noticed may be summed up in the language 
of the celebrated Dr. Massy, in his instruc- 
tions and directions on the subject of the 
treatment now under consideration. He 
observes, " But, as you draw blood, stimu- 
late, give punch, brandy, or wine and 
water, or carbonate of ammonia. Apply 
friction, with stimulating and hot liniments 
to the extremities ; warm sand-bags to the 
feet, sinapisms to the calves of the legs and 
pit of the stomach ; for, if you can once 
raise the pulse, the chances in favor of re- 
covery will be vastly increased." 

To these directions there can be no special 
objections, except in the first instance in 
which he, indirectly, commends the use of 
means tending to deplete and depress the 
system, already brought by disease to the 
very verge of utter exhaustion. Remedies 
of this tendency are contra-indicated, and 
cannot, to say the least, be employed to 
advantage. 



114 ASIATIC CHOLERA. 

Depressing remedies generally, instead 
of cheeking, or counteracting the disease, 
will inevitably aid and hasten its fatal ter- 
mination. Stimulants, such, as are prompt 
and diffusive in their character, must be 
regarded as essential, and may be employed 
to great advantage. It will be found, how- 
ever, exceedingly difficult in most cases, 
even where there is no depletion from 
bleeding, to keep up the waning powers, 
and carry the patient, through this formi- 
dable disease, to a favorable termination. 
Of the utility of warm applications to the 
surface generally, there can be no question ; 
yet, our main reliance is on internal rem- 
edies, as has been already shown : the 
lost temperature of the body must be re- 
stored, the production and diffusion of heat, 
or caloric, must be internal through the ad- 
ministration of remedies, that will promptly 
and kindly produce this result. 

What are, then, the remedies? We have 
ventured in this discussion to recommend 
the internal use of chloroform, and believe 
it will be found in combination with other 



CONDITION OF THE BLOOD. 115 

prompt and diffusive stimulants, specially 
adapted to meet this condition. In this rec- 
ommendation, we feel ourselves fully sus- 
tained by the result of various experiments 
heretofore made, and the recent trials of 
its use, as an internal remedy in the various 
stages of the disease. 

The earliest record of the use of chloro- 
form in cholera is probably to be found in 
the London Lancet for November, 1848, in 
which Dr. Hill reports a case of its success- 
ful use by inhalation. He placed the pa- 
tient in bed, covered with warm blankets, 
and applied friction, stimulant liniments, 
and heated bags of bran to the surface, and 
kept the patient under the gentle influence 
of chloroform, till the more urgent symp- 
toms entirely subsided. At intervals brandy- 
and-water, and thin arrow-root or milk 
was given. All other medicines were 
avoided. Though the urgent symptoms 
returned at first, as the effects of the chlo- 
roform passed off, they were easily con- 
trolled by the repetition of the inhalation. 
By persevering in its use, reaction set in, 
and the patient became convalescent. 



116 ASIATIC CHOLERA. 

Other cases, afterwards, were treated in 
the same way, with a similar result. Some, 
however, required the gentle use of chloro- 
form by inhalation, at intervals, for twenty- 
four hours ; after which, none seems to have 
been administered. For aught that appears 
these cases all recovered. 

Another very interesting case is related 
by Mr. Brady, who observes that an elderly 
lady was seized with slight diarrhoea, which, 
on the following morning, had become very 
profuse : excessive vomiting supervened, ac- 
companied by spasms in the calves of the 
legs, fingers and toes. Under these urgent 
symptoms, the usual remedy, brandy, was 
administered without avail ; the dejections 
became incessant, and the spasms increased 
in intensity, presenting the features of a 
decided case of malignant cholera. In this 
condition, the physician was called in haste, 
as it was believed and affirmed the patient 
was dying. In describing this case, the 
physician observes : " On my arrival, I 
found the patient presenting all the symp- 
toms of malignant Asiatic cholera, in an 



CONDITION OF THE BLOOD. 117 

advanced stage ; the features collapsed and 
ghastly ; extremities and tongue cold ; burn- 
ing sensation in the stomach and oesopha- 
gus ; pulse rapid and scarcely perceptible ; 
voice diminished to a whisper ; stomach 
exceedingly irritable, and the dejections 
from the bowels presenting the character- 
istic rice-water appearance ; and all the 
voluntary muscles of the body were affected 
by spasm, so that the patient actually 
writhed in agony." Ordered the following : 
5. Chloroform 3j ; 01. Terebinth. |j; aq. 
Dist. 3iij. M. And gave immediately a 
large tea-spoonful, in a wine-glass, of dilute 
brandy ; and applied sinapisms to the calves 
of the legs and abdominal and thoracic 
surfaces. Thirst was relieved by drinking 
plentifully of water nearly cold. Though 
the stomach was irritable, the chloroform 
was retained, as well as the fluid drank 
after it, and was followed by no dejection. 
Half an hour after, two pills were admin- 
istered, composed according to the follow- 
ing: E. Calomel gr. v; fellis. bov. inspis. 
gr. x ; Ft. Pil. ij. Half an hour after these 



US ASIATIC CHOLERA. 

were given, vomiting ensued, but soon sub- 
sided ; the diarrhoea had apparently ceased ; 
the cramps had diminished in frequency 
and severity. A second dose of chloro- 
form, now one hour after the first, was ad- 
ministered, and soon after this two more 
of the pills, both of which were retained, 
and gave decided relief. The pulse rose in 
power and became slower, the spasms less 
frequent, and, in an hour after the second 
dose, the patient was bathed from head to 
foot in a warm perspiration, and expressed 
herself comparatively free from all uneasy 
sensations. The attack had been completely 
subdued, leaving behind a good deal of 
pyrexia and debility, from which she rap- 
idly recovered. 

Here it is worthy of notice, that in this 
case, severe as it was, only two doses of 
the chloroform mixture were administered, 
each containing about six minims of chloro- 
form and forty of turpentine ; the pills 
would naturally tend to perpetuate rather 
than relieve the nausea and vomiting, and 
in one hour after the administration of the 



CONDITION OF THE BLOOD. 119 

second dose, all the urgent symptoms were 
assuaged. 

In another case, the attending physician 
reports that, after giving calomel, combined 
with opium, which was immediately rejected, 
the following mixture was ordered : B . Chlo- 
roform vj minims ; brandy 3iij ; water 
liijss, one-third of which was given im- 
mediately, and was thrown up in half an 
hour ; a second dose was then given, and 
was retained. The vomiting and diarrhoea 
ceased ; the spasms became less severe. In 
two hours after, gave the remaining third 
part ; and during the next six hours, ad- 
ministered in two doses six minims more of 
the chloroform, with the most decided bene- 
fit, and the patient soon became convales- 
cent. To the extreme tenderness over the 
region of the epigastrium flannel soaked in 
spirits of turpentine was applied ; and as 
no urine was secreted, I am firmly of the 
opinion that the usual remedies would not 
have met this case. " I candidly confess," 
says the physician, " I had no hope of suc- 
cess from its severity ; and, but for a knowl- 
11 



120 ASIATIC CHOLERA. 

edge of Mr. Brady's case, I believe I should 
have lost my patient." 

Dr. Davies reports a case in which he 
used chloroform fifteen hours after the 
seizure with relief, but not with success, 
and observes that, in a number of cases oc- 
curring in the hospital, there were 22 cases 
in which, as severe symptoms came on, the 
chief remedy was chloroform, administered 
internally, in doses of from seven to ten 
minims every hour, half hour, or quarter of 
an hour, according to the severity of the 
symptoms. Of these 22 cases, 8 terminated 
fatally, and 14 recovered. 

Again : " Out of 9 cases of cholera, and 13 
of the worst cases of diarrhoea occurring in 
my own practice, and treated with chloro- 
form, one died. All these were in the better 
ranks of life. In some of them, the warm 
bath (salt water) was used as an auxiliary, 
and the diet consisted of nothing but cold 
milk and water, with some carbonate of 
soda, ad libitum. The fatal case was that 
of a drunkard, who, probably, did not take 
the remedy. These cases varied in severity, 



CONDITION OF THE BLOOD. 121 

from sickness and diarrhoea, and mild col- 
lapse, to sickness, diarrhoea, severe cramps, 
and great collapse, with almost clear watery 
evacuations, passing away involuntarily * * 
Of 14 cases of cholera treated by Mr. 
Towers, Medical Resident of the Infirmary, 
many of them under my own observation, 
one died. The fatal case was that of a 
woman aged 63, who was previously suffer- 
ing great depression, consequent on extreme 
destitution." 

Again, says Dr. Davies, " It will prob- 
ably be remembered that, in my second 
report, I expressed a very favorable opinion 
of chloroform in this deadly malady. I 
considered I had strong grounds for so 
doing, after observing the large proportion 
of cases which recovered under its ad- 
ministration. Prom the history of this last 
visitation in the county prison,* however, 
the fact turns out, that, under some un- 
certain circumstances, the use of chloro- 
form will not prevent the proportion of 
deaths being considerable. I have reason 
to believe that it was, from over-anxiety, 



122 ASIATIC CHOLERA. 

given in too frequent doses in some cases, 
and that it thus rather added to the coma, 
which is one of the characteristics of the 
malady. 

At the commencement of thp outbreak, 
the doses were repeated every hour, or 
every two hours, and it is to be noted that 
the first seven cases recovered. 

As the cases multiplied, the remedy was 
given every half hour, and, in some in- 
stances, every quarter of an hour ; the re- 
sult was that the next six cases died. 
Whether these cases had anything in them 
inherently more fatal, it is difficult to tell. 
The symptoms at first were about equal, and 
the differences did not show themselves until 
towards the end. There was next a recov- 
ery of seven cases in succession ; in these 
the remedy was administered less frequently, 
but subsequently two deaths occurred under 
the less frequent administration. 

The chloroform was administered also by 
inhalation, in some of the more severe cases 
of cramps, with the effect of affording relief 
in every instance. The inhalation was not 



CONDITION OF THE BLOOD. 123 

carried so far as to produce insensibility. 
Although I am still of the opinion that chlo- 
roform properly regulated is the remedy of 
all others hitherto tried to be depended on, 
yet it cannot be considered a specific for 
cholera." 

Mr. Steadman reports a very interesting 
case treated by chloroform. He observes, 
" The spasms were universal and extremely 
violent, as if knots were being tied in the 
bowels, countenance livid and cold, voice 
feeble, and all medicines rejected. In this 
condition gave chloroform combined with 
' aqme vitas 7 and distilled water. The 
first dose had a partial but most satisfactory 
effect. In two hours after, as the symptoms 
manifested a disposition to return, gave a 
second dose, which entirely controlled all 
spasms, vomiting and purging. The patient 
was ordered cold rice and mucilaginous 
drinks, and had the chalk mixture with 
nitric ether prescribed. A dose of oxgall 
(gr. x) was given in course of the day, which 
produced the desired effect. In two days 
the patient was declared convalescent." 
11* 



124 ASIATIC CHOLERA. 

The daughter, who had nursed the mother 
in this case, was seized soon after in a sim- 
ilar manner, except the dejections were 
more abundant and frequent. The mother 
having some of the chloroform mixture left, 
gave it to the daughter without advice or 
hesitancy, and obtained the same magic re- 
sults. The first dose was only partial in its 
effect, but the second completely subdued 
the disease. 

Such are the results of some of the experi- 
ments which have been made by the admin- 
istration of chloroform ; and, so far as ap- 
pears, the first cases treated by inhalation 
were severe malignant cholera in the ad- 
vanced stage, all of which recovered. So, 
also, those treated by the remedy used in- 
ternally, combined with a prompt and de- 
cided stimulant like the spirits of turpen- 
tine, or aquas vitse and brandy, recovered. 
In all these cases the remedy appeared to 
meet the urgent demand, to remove the im- 
pediment to the circulation, to relieve the 
nausea and vomiting, and purging and 
cramps, and restore, in a very short time, 



CONDITION OF THE BLOOD. 125 

the general action and normal tone of the 
system. Still we must admit, that some 
cases, treated by its internal administration, 
and also by inhalation, proved, on some 
accounts not satisfactorily explained, unsuc- 
cessful. Were these cases given in detail, 
it would be much easier to detect the cause 
of failure, or its questionable use in such 
cases ; but we have only the bare fact that 
they were thus treated, without the manner 
or character of the combination, if any were 
made, being given. 

Hence Dr. Davies, under whose direction 
these cases occurred, remarks, in view of 
this result, ' : that no reliance could be placed 
on chloroform alone." The correctness of 
this opinion cannot be questioned, for the 
experiments we have cited all show the ne- 
cessity of a prompt and diffusive stimulant 
in aid of its action, to render it sufficiently 
prompt and powerful to meet and overcome 
the disease in the more rapid and severe 
cases. Chloroform, properly combined, 
offers the best hope of relief, and is, without 
doubt, the most perfectly adapted of any 



126 ASIATIC CHOLERA. 

remedy known to the pathology and phe- 
nomena of the disease. There is no remedy, 
when properly combined, so capable of 
meeting all the indications required as this, 
and none that can be administered with 
more certainty of success. 

In conclusion, we may, with much pro- 
priety, refer again to the pathology suggest- 
ed by the authors cited above, and inquire 
whether the action of chloroform as a rem- 
edy in these cases be consistent? and 
whether as such it has that curative influ- 
ence, or direct controlling power, to arrest, 
suspend, and cure the disease, so imperiously 
demanded ? We have seen that, according 
to the opinion generally prevailing, the first 
impression of the poison is made upon the 
blood, and through it upon the nerves, espe- 
cially those which, from their anatomical 
position, bear the most intimate relation to 
the blood-vessels. Through this channel 
the first invasion appears to be made on the 
ganglionic, the nerves of circulation. These 
nerves are distributed chiefly to the viscera 
and blood-vessels, and are at least very 



CONDITION OF THE BLOOD. 127 

early involved and essentially disturbed, for 
their healthful action depends in no small 
degree on the aeration or oxydation of the 
blood. Says an eminent author, " The action 
of every ganglionic mechanism depends on 
the existence of certain physical conditions, 
among which the most prominent and im- 
portant is the due supply of arterialized 
blood. If this be stopped but for a moment 
the nerve mechanism loses its power, or, if 
diminished, the display of its characteris- 
tic phenomena correspondingly declines." 
Hence the loss of power in these nerves, 
and their deranged action, the contraction 
of the capillary and pulmonary arteries, the 
impaired and impeded circulation and all 
the phenomena arising therefrom. 

Again, the great pneumogastric nerve, 
which is composed of both motor and sen- 
sitive filaments, has a very extensive distri- 
bution in the upper part of the abdominal 
cavity. It supplies the organs of voice and 
respiration with motor and sensitive fibres, 
and the pharynx, oesophagus, stomach and 
heart with motor influence. This very im- 



128 ASIATIC CHOLERA. 

portant nerve, through the primary action 
and deteriorating process of the cholera 
poison, becomes early involved, and its 
functions greatly, and, in fatal cases, per- 
manently deranged. The evidence of this 
disturbance and loss of nerve-power is too 
obvious to be overlooked or disregarded in 
the treatment of this disease. 

In confirmation of this, we may, with 
great propriety, adduce the testimony of 
Dr. Wallis on the loss of nerve-power, and 
the process through which the result is pro- 
duced, who observes, that " the phenomena 
which are exhibited when the deleterious 
air has been drawn into the lungs are these : 
the great gastro-pulmonary nerve is either 
wholly or partially paralyzed, the conse- 
quences are the cessation of all its functions 
either wholly or partially. This great 
nerve is a nerve of function, and performs 
the functions of digestion and respiration, 
and influences all secretions." 

Hence it appears the nervous power gen- 
erally, as before observed, is very early and 
essentially impaired, and to such an extent 



CONDITION OF THE BLOOD. 129 

that there can be no rational hope of relief, 
unless some remedial agent can be found 
that will exercise such a controlling influ- 
ence and power, as shall be adequate to re- 
store the tone of the nervous system. 

Hence, we are forced to the conclusion 
that the prominent, leading, and most 
urgent symptoms requiring special atten- 
tion, are " the Algide" or loss of tempera- 
ture, the loss of nerve-power in the gangli- 
onic and pneumogastric nerves and their 
branches, the altered or disorganized con- 
dition of the blood, the impaired or ob- 
structed circulation, and the early and 
direct tendency to congestion. These are 
the prominent and essential features to be 
observed in the treatment. They are too 
intimate, dependent and inseparable, to war- 
rant any attempt to mark the precise order 
of their development. They are the essen- 
tial phenomena, proceeding equally and 
directly together from the primary cause 
and disease action, and strictly constitute 
the complex character of the cholera, and 
exhibit its main, distinguishing features, 



130 ASIATIC CHOLERA. 

which must necessarily govern and dictate 
the maxims of rational practice in the treat- 
ment of this disease. The object, then, of 
first importance is to restore the lost tem- 
perature, the caloric already eliminated, and 
prevent its further depression ; to restore, at 
the same time, the lost nerve-power to the 
nerves again ; to arrest the process of dis- 
organization of the blood, and equalize the 
circulation ; to relieve and suspend the con- 
gestion ; and then, according to all the ex- 
periments which have been made, the conse- 
quent and dependent phenomena of the 
cramps and the vomiting and the purging 
will disappear. 

Section III. — Different Modes of 
Treatment. 

After speaking of the various expedients 
resorted to for the cure of cholera, says 
Dr. Watson : " I believe that each, in some 
cases, did good, or seemed to do so ; but I 
cannot doubt that some of them did some- 
times do harm. I had not more than six 



DIFFERENT MODES OF TREATMENT. 131 

severe cases under my own charge, and I 
congratulated myself that the mortality 
among them was not greater than the aver- 
age mortality. Three died, and three, I 
will not say were cured, but recovered, * * * 
under large and repeated doses of calomeL 
Yet, as I said before, I do not venture to 
affirm that the calomel cured them." It 
seems that Dr. Latham commenced the treat- 
ment and Dr. Watson followed it up, re- 
peating the half-drachm doses of calomel 
many times, as the patients seemed to rally 
after its administration. Again, he ob- 
serves : " It was remarked of those who 
recovered, that some got well rapidly and 
at once, while others fell into a state of 
continued fever, which frequently proved 
fatal, some time after the violent and pecu- 
liar symptoms ceased. Some, after the 
vomiting and purging and cramps had de- 
parted, died comatose — over-drugged — some- 
times, it is to be feared, by opium. The 
rude discipline to which they were subject- 
ed might account for some of the cases of 
fever." * * * " Never, certainly, was the 
12 



132 ASIATIC CHOLERA, 

artillery of medicine more vigorously plied, 
never were her troops, regular and volun- 
teer, more meritoriously active. To many 
patients, no doubt, this busy interference 
made all the difference between life and 
death. But if the balance could be fairly 
struck and the exact truth ascertained, I 
question whether we should find that the 
aggregate mortality from cholera in this 
country was any way disturbed by our, 
craft 77 

In a report by the acting physician to the 
Bellevue Hospital, made to the u Special 
Medical Council, 77 August 2d, 1832, while 
the Epidemic Cholera was still prevailing 
there and in the city, the physician says : 
u The treatment I have divided into two 
kinds — the pathological and the mixed. 
The first having been determined on, after 
the careful examination of twenty -three 
persons dead of cholera; since then, ten 
more have been examined, which serve to 
confirm the conclusions first formed. 

Pathological Treatment — First Stage: 
This consisted in the administration of blue 



DIFFERENT MODES OF TREATMENT. 133 

pill and opium with absolute diet. If pain 
was present, leeches to the epigastrium and 
arms, and when these could not be pro- 
cured, cups to the epigastrium. This plan 
never failed to arrest the disease in the 
hands of those who diligently pursued it, 
where the mucous membrane of the gastro- 
intestinal canal was not previously dis- 
eased. 

Second Stage. — First, Blood-letting ; sec- 
ond, diligent frictions with the ointment 
alluded to above, when persons could be 
procured to perform the duty ; third, ice 
to allay the thirst ; fourth, small doses of 
brandy and laudanum, if the vomiting con- 
tinues ; fifth, cups to the epigastrium, if there 
was pain and the brandy omitted. 

Third Stage. — First, ice to allay the thirst, 
which is now, indeed, unquenchable ) second, 
external heat ; third, a continuation of the 
frictions ; fourth, no opium, and, frequently, 
no brandy, especially among the children. 

Mixed Treatment — First Stage. — Be- 
sides the above treatment, calomel and Do- 
ver's powders was a very frequent prescrip- 



134 ASIATIC CHOLERA. 

tion ; also scruple doses of calomel, and calo- 
mel and opium in small doses, and all with 
success. Nevertheless, I believe they oc- 
casionally did harm. 

Second Stage. — First, blood-letting less 
frequent than above ; second, calomel and 
Dover's powders continued ; third, calomel 
and opium ; fourth, calomel, capsicum and 
opium ; fifth, soda powders ; sixth, scruple 
doses of calomel every half hour ; seventh, 
ice. 

Third Stage. — Calomel and Dover's pow- 
der ; calomel and opium ; calomel, capsicum 
and opium ; carbonate of ammonia and capsi- 
cum ; scruple doses of calomel every half 
hour. External heat in various ways ; ice, 
etc. Severe shocks of electricity along the 
course of the muscles to allay the cramps ; 
also, the burning of alcohol on the skin. 
The first was the practice of Dr. Devan, 
the second, that of Dr. Gardner, and both 
lay claims to having been the first to use 
these means." 

The ointment alluded to above is com- 
posed of mercurial ointment, one pound, 



DIFFERENT MODES OF TREATMENT. 135 

camphor finely pulverized, seven ounces, and 
the same quantity of capsicum. With this, 
the patient was rubbed briskly from head 
to foot and repeated at short intervals. The 
result was, that mercury generally showed 
its specific effects upon the gums in from 
five to ten hours from the commencement 
of reaction. The success of this external 
application of mercury, conjoined with its 
internal administration and frequent blood- 
letting, may be learned from the cholera 
statistics of this and other institutions. 

Dr. Pereira employed sixty-grain doses 
of calomel, it is said, with success, and Dr. 
Barton of New Orleans, in 1849, gave in 
ten cases from 120 to 150 and even to 180 
grains of calomel at a dose, and, in one 
case, gave 220 grains, intending, it is said, 
to have weight sufficient to keep it down. 
This brave and heroic practice did not af- 
ford relief in a single instance ; the cramps, 
and vomiting, and purging continued, and 
a few hours closed the scene — -all died. 

The treatment recommended in the Amer- 
ican Practice of Medicine, by Dr. W. Beach, 
12* 



136 ASIATIC CHOLERA. 

which was fully tested by the author him- 
self while in discharge of his official duties 
as physician of the Tenth Ward, city of 
New York, during the prevalence of chol- 
era in 1832, is worthy of consideration on 
account of its simplicity, its great efficiency 
and wonderful success. " Among all the 
medicines," says the author, " ever given or 
proposed in the incipient or premonitory 
stage, none will be found so efficacious as 
our neutralizing mixture, made of genuine 
materials and given very strong. Occa- 
sionally, it may be proper to add fifteen or 
twenty drops of laudanum ; this, however, 
is very seldom necessary. A vast number 
of medicines are recommended in this stage 
of cholera, but there are none, I am con- 
vinced, so efficacious as the above." 

In the second, or confirmed stage, the 
same medicine was continued in larger and 
more frequent doses, with hot fomentations 
to the abdomen, stimulating lotions, sina- 
pisms and injections. The cholera drops 
were also administered, composed according 
to the following formula : 



DIFFERENT MODES OF TREATMENT. 137 

5. Tincture of Capsicum, 

Tincture of Opium, 

Spirits of Camphor, 

Essence of Peppermint. 

Equal parts — mix. 
Give a tea-spoonful every hour or half 
hour, according to the severity of the symp- 
toms. 

In the third, or collapsed stage, he di- 
rected a tea-spoonful of pulverized black 
pepper to be mixed and given in a tumbler- 
ful of hot gin-sling ; also, the same to be 
prepared and applied hot to the bowels and 
extremities. Also, to two tea-spoonfuls of 
either pulverized red or black pepper, pour 
on a sufficient quantity of hot water, let it 
stand till nearly cold ; strain and inject 
the whole up the bowel. This would often 
arouse the patient in the collapsed stage 
when there was little or no hope of recov- 
ery. Such are in brief the remedies which 
were used so successfully in the Tenth 
Ward of this city, in 1832. Here it will 
be noticed that the general principal evolv- 
ed in this treatment consists in its prompt 



138 ASIATIC CHOLERA. 

and diffusive stimulant, its antispasmodic 
and corrective power so combined as to 
act gently and kindly, yet promptly and 
successfully, as the records show, to which 
we shall refer in the sequel. 

Another mode worthy of a passing notice 
is one analogous to this, adopted and rec- 
ommended by the eminent Dr. G. S. Haw- 
thorne, of Liverpool, England, who ob- 
serves : " Of the medicinal remedies, the chief 
is opium. This, I have explained, should 
be given in combination with medicines of 
a cordial, stimulating and antispasmodic 
character, of which the most efficient are 
camphor, capsicum, ether and aromatic 
spirits of ammonia. The following formulas 
present the combination of the medicines 
which I would prefer : 

$. Powdered Opium, . . . gr. xij. 

Camphor, gr. xxx. 

Capsicum, gr. ix. 

Spirits of wine and conserve of roses Q. 
S. — mix: — divide into twelve pills. Each 
of these pills, it will be observed, contains 



DIFFERENT MODES OF TREATMENT. 139 

one grain of powdered opium. These are 
accompanied with the following : 

3. Chloric ^Ether, 

Aromatic Spirits Amomnia, 
Camphorated Spirits, 
Tincture of Capsicum. 

Of each, one drachm. 
Cinnamon water, two ounces — mix. 

" Cholera/ 7 observes Dr. H., " presents 
itself in four distinct degrees of malignity. 
All the modifications of the disease require 
to be treated on the same principles, the 
only difference being that, in the detail, the 
milder forms require less powerful doses of 
the medicines. The mode of treating the 
most malignant form of the disease, will 
serve as a model on which all the others 
are to be treated. This most malignant 
form has, by all writers on the subject 
hitherto, been pronounced incurable. They 
say it never was cured in a single instance, 
and never can be cured by the power of 
medicine. I shall, however, point out a 
mode of treating it which will prove itself 



140 ASIATIC CHOLERA. 

infallibly successful where my directions 
are followed with sufficient promptness, 
boldness and skill/ 7 In detailing the mode 
of procedure, the doctor observes : " Place 
the patient immediately in the horizontal 
posture in bed, and give him on the instant, 
as this is an extreme case, ten of the anti- 
spasmodic pills, and two ounces of the anti- 
spasmodic mixture, and wash the whole 
down with a glass of undiluted brandy or 
whisky, flavored strongly with cloves, es- 
sence of ginger, or some such warm aro- 
matic spice. In the mean time, have him 
covered with an additional blanket, and let 
the usual means of communicating heat> 
such as jars or bottles of hot water, bags of 
hot salt or sand, hot bricks, or whatever can 
be most readily procured, be applied with- 
out delay to the feet and different parts of 
the body, so as to restore the temperature 
and produce perspiration as quickly as pos- 
sible. As soon as the perspiration has be- 
gun to flow freely, superadded to the medi- 
cines and cordials already administered, a 
glass of brandy-punch should be given, the 



DIFFERENT MODES OF TREATMENT. 141 

punch to be made strong and to be swal- 
lowed hot as possible. After this, no drink 
should be given until the perspiration has 
flowed freely for a few minutes. The stom- 
ach will then retain it, and the patient 
should be indulged freely with copious 
draughts of rennet whey, warm toast-water, 
flavored with some agreeable spice, mint, or 
balm-tea, or any such mild beverage. The 
necessity of attending to this is most im- 
portant. When the discharges from the 
bowels cease, and when the pulse becomes 
full and bounding, the body is covered with 
a copious, warm perspiration, which will 
not fail to be the case under such treatment ; 
the danger is over. The perspiration, if 
the patient can bear it, should be kept up 
for twelve hours, and may, with advantage, 
be continued moderately even longer. Its 
duration, however, must be regulated ac- 
cording to the strength of the patient and 
the state of the pulse. After the first four 
or six hours, more heat need not be applied 
than is perfectly agreeable to the feelings 
of the patient. It is remarkable how sud- 



142 ASIATIC CHOLERA. 

deniy the precordial oppression, etc., are 
relieved on the breaking out of a free per- 
spiration, and, what is of greater import- 
ance still, the vomiting, where it exists, im- 
mediately ceases. 77 In short, all the urgent 
symptoms soon subside, and the patient be- 
comes convalescent. 

Such is Dr. Hawthorne's treatment, which 
is affirmed to have been invariably success- 
ful. It is based on the same general prin- 
ciple as the preceding — a prompt and dif- 
fusive stimulant. Here we might ask, What N 
constitutes the chief reliance in the for- 
mulas ? Was it the opium that so promptly 
met and arrested the disease ? or the com- 
bination of the other powerful stimulants 
with which it was united ? Dr. H. places 
his main reliance on this drug, and yet af- 
firms that it produced no narcotism or other 
sensible effect whatever, except as a diapho- 
retic, and even in this its influence may be 
questioned. The prognosis becomes favor- 
able from the fact of a sudden rise in the 
temperature of the body, for the icy-cold- 
ness disappeared, the heat of the surface 



DIFFERENT MODES OF TREATMENT. 143 

returned, the circulation was equalized and 
a profuse perspiration set in, and, as these 
conditions appeared, the urgent symptoms 
subsided. Not the excessive doses of opium,, 
but the remedies in combination as a whole,, 
produced by its prompt stimulating power 
these results, and the patient was thus re- 
lieved. 

Mr. Forward, while superintending some 
of the public works in the State of Ken- 
tucky, in 1832, had in his employ more than 
two hundred laborers, among whom the 
Cholera Epidemic of that year appeared 
about a week before its irruption in Louis- 
ville. The first case was that of a young, 
sober, industrious white laborer, who was 
at the time vigorous and apparently healthy. 
It was a sudden and severe, case and oc- 
curred about eleven o'clock at night. The* 
physicians who usually attended these men 
were at a distance, and could not be obtain- 
ed without considerable delay. Under 
these circumstances, Mr. Forward, after vis- 
iting the patient, becoming acquainted with 
the symptoms, and believing it a genuine 
13 



144 ASIATIC CHOLERA. 

case of cholera, commenced treatment at 
once, fearing, as lie states, the patient could 
not live till a physician could be obtained. 
It was, indeed, a desperate case ; violent 
spasms, with constant vomiting and severe 
purging, attended with that livid appear- 
ance and peculiar coldness so characteristic 
of the disease. " Of the treatment," says 
Mr. Forward, " I gave him first a quick, 
stimulating emetic prepared from the lobelia 
seed, which checked the vomiting and purg- 
ing, but had little effect upon the spasms. 
I then applied the steam bath, having his 
feet and legs at the same time immersed 
in water as warm as he could bear, 
which was made strong with salt and 
wood ashes. I then sweetened a tumbler 
of warm water and put into it a tea- 
spoonful of " number six," and about the 
fourth part of a tea-spoonful of Cayenne pep- 
per, and gave him one-third of it when I 
commenced sweating him, and the balance 
at intervals while he was sweating. By 
the time he had been sweated ten minutes, 
he was free from spasms and pain, but I 



DIFFERENT MODES OF TREATMENT. 145 

continued the sweating ten or fifteen min- 
utes longer, then wiped dry, after which 
the patient laid down and went to sleep — ■ 
being thus relieved and cured." 

Another case of a colored man who was 
strictly temperate and healthful occurred an 
hour or two later the same night. His at- 
tack, too, was sudden, and still more severe ;• 
cramps very violent, vomiting and purging 
equally as severe, though he had not been 
awakened from his slumbers more than fif- 
teen minutes. This case was treated the 
same as the former, with the emetic, sweat- 
ing, and when the sweating had subsided, 
administered a table-spoonful of spirits of 
turpentine, which relieved him entirely, and 
he soon went to sleep. The next morning 
both were comfortable, and went to work 
and remained well. During the prevalence 
of cholera at that time, Mr. Forward had 
thirteen cases in his own family, and, on one 
day when the epidemic was at its height, 
seven cases among the laborers. All these 
and many others that occurred were treated 
in the same manner, with the same undevi- 



146 ASIATIC CHOLERA. 

ating success. Not a single instance of death 
from cholera in his own family, or among 
the hands on the road. When the epidemic 
cholera reappeared in 1835, the same course 
of treatment was pursued, with the same 
uniform success. Such results, considering 
the malignant character of the disease, are 
truly astonishing. Whatever may be said 
of the general principle of practice in these 
cases, its success must be admitted as 
equaling, if not surpassing, the treatment 
of any equal number of cases on record. 
Though conducted by an unpretending and 
unprofessional gentleman, yet, out of the 
whole number attacked during the contin- 
uance of the epidemic, not a single case 
was lost. 

In a report of a case of cholera treated 
successfully by rectified oil of turpentine, 
administered internally as a specific, by 
Richard Brown, Esq., Surgeon, Cobham, 
Surrey, November, 1848, it is stated that 
the patient, " aged fourteen, having suffered 
from severe bowel complaint, presented all 
the symptoms of cholera in the stage of col- 



DIFFERENT MODES OF TREATMENT. 147 

lapse. The bowels acted incessantly, and 
anything taken into the stomach was imme- 
diately rejected ; the pain around the um- 
bilicus was intense, attended with severe 
cramps of the legs ; the pulse exceedingly 
small, and scarcely perceptible ; tongue 
coated in the centre, and flabby ; the sur- 
face of the body much below the natural 
standard ; the countenance of a blue cast, 
and expressive of the greatest anxiety. So 
decided, indeed, was the symptom that the 
case was considered almost without hope." 
" But I had determined/ 7 says the physician 
" to treat the first case of cholera that oc- 
curred in my practice with rectified oil of 
turpentine, given internally, the active prin- 
ciple of which, camphogen, possesses stimu- 
lating, diuretic, diaphoretic, sedative, anti- 
spasmodic, antiputrescent properties. I ad- 
ministered immediately one drachm of it 
combined with mucilage and aromatics, di- 
recting it to be repeated every two hours,, 
the patient to be kept warm and to take* 
meal broth with excess of salt. 77 

Now mark the result of this simple, uir- 
13* 



148 ASIATIC CHOLERA. 

combined remedy. In the evening of the 
same day all the urgent symptoms were as- 
suaged, the purging and vomiting had 
ceased, the pulse was raised, the surface of 
the body had become warm and moist with 
perspiration, the pain around the umbilicus 
diminished, and the cramps less violent, but 
the countenance still bore the appearance of 
great anxiety. Such were the immediate 
results of the administration of this remedy, 
which appear, from the subsequent history 
of the case, to have been permanent and un- 
attended with any constitutional derange- 
ment, or other serious and unpleasant effect. 
On the morning of the next day the patient 
was steadily improving ; much of the anx- 
iety of countenance had vanished, but the 
pain in the belly and cramps of the legs 
still remained, though much relieved. On 
the second morning after the attack the 
patient was very much better ; no pain in the 
belly, and does not feel sick from the tur- 
pentine. On the third morning the patient 
was up, and, though exceedingly weak, there 
was no trace of any alarming symptom re- 



DIFFERENT MODES OF TREATMENT. 149 

maining. The bowels had moved from the 
effects of a previous dose of calomel (two 
grains) given the next morning after the 
attack, and the evacuation was much more 
healthful. A mild tonic and alterative 
plan of treatment was all that was neces- 
sary to restore the patient to her usual 
health, and she is now well. The remedy 
was given at first every two hours, then 
every four, and lastly every six hours. 
This treatment commenced on the 26th and 
terminated on the morning of the 29th. Its 
duration about sixty hours, when the patient 
is declared convalescent and comparatively 
well. Here we might ask, What experiment 
with any single remedy has been more im- 
portant and satisfactory in indicating and 
directly pointing out a general principle of 
practice for the successful treatment and 
cure of this formidable disease ? We say 
single remedy, for it is doubtful whether 
the two grains of calomel exercised any 
curative influence whatever, or in any way 
varied the result. It is, therefore, to the 
use of the rectified oil of turpentine that 



150 ASIATIC CHOLERA. 

the favorable termination and cure of the 
disease is to be attributed. 

There is another mode of practice which 
has been exhibited to some extent in almost 
every part of the world, claiming to be 
more efficacious and successful than any 
other in the cure of epidemic cholera. It 
is the general principle which is the great 
and important consideration with which 
we are concerned in presenting it among 
the various modes adopted for the cure of 
this disease. This is found clearly defined 
and ably presented by Dr. Joslin in his 
lecture on cholera, in which, after exhibiting 
the views and doctrines governing the prac- 
tice, and contrasting its results with those 
of other modes, he observes, in relation to 
the treatment of cholera in its early stages, 
that " whatever may be the form of attack, 
give one drop of the tincture of camphor 
dropped on a lump of sugar, and then dis- 
solved in a table-spoonful of cold water. 
Eepeat this every five minutes until there 
is a decided mitigation of the symptoms. 
This will usually be after five or six doses. 



DIFFERENT MODES OF TREATMENT. 151 

If the disease be taken in time, ten or 
twelve closes are ordinarily sufficient. There 
is abundant testimony of the efficacy of this 
camphor treatment from all parts of Eu- 
rope." Again, speaking of the first variety, 
in which the most prominent symptom is 
diarrhoea, the Dr. observes, " If camphor 
does not soon give relief, we are to resort 
to phosphorus, or to phosphoric acid. Dr. 
Quinn has employed both with equal suc- 
cess. Phosphoric acid is to be preferred 
when there is a gluey matter on the tongue. 
In some cases, veratrum, chamomilla, mer- 
curius, or secale may be indicated. How- 
ever, phosphorus and phosphoric acid 
rarely fail to cure ; and some high authori- 
ties are in favor of giving one of them at 
first, in preference to the administration 
of camphor in this form of cholera." 

Again, in the second variety, cholera gas- 
trica, Dr. Joslin observes, that " the reme- 
dies are generally ipecacuanha or veratrum, 
sometimes nux vomica. Camphor is to be 
given at the outset. Put two or three 
globules of the third of ipecac, in a little 



152 ASIATIC CHOLERA. 

sugar of milk and place them on tlie tongue. 
This may be repeated, if necessary, in half 
an hour, an hour, or an hour and a half. 
But if the disease is not checked, give vera- 
trum or other medicines according to the 
different indications." Again, in the third 
variety, cholera spasmodica, " the remedies 
are camphor, cuprum metalicum, and vera- 
trum. If camphor has not relieved, give 
cuprum, and repeat it many times, at inter- 
vals of half an hour or an hour, if its salu- 
tary effect is not manifested. If necessary, 
then give veratrum in repeated doses, or 
other medicines, according to the different 
indications." In the fourth variety, cholera 
sicca, " there is no diarrhoea or vomiting ; 
there is sudden prostration of the vital 
powers," etc. " The first remedy, as in 
other varieties, is camphor. If the patient 
is cold, blue, pulseless, that is, collapsed, 
carbo vegetabilis ; some recommend hydro- 
cyanic acid." In the fifth variety, cholera 
acuta, veratrum is named as the main 
remedy. 

Such is, in brief, the treatment so highly 



DIFFERENT MODES OF TREATMENT. 153 

extolled and recommended by some in the 
cure of cholera. It is, in substance, the 
same as was originally suggested when the 
disease first appeared in Europe, nearly 
half a century ago, and will probably con- 
tinue unchanged for generations to come. 
Of its general principle and its adaptation 
to the pathology of the disease we shall 
speak more at length in the sequel. 

After referring to the pathology of the 
epidemic cholera, showing its strong analogy 
to congestive fever, from the fact that in 
both diseases the blood recedes from the sur- 
face, and collects upon the internal organs, 
inducing a state of congestion, and showing 
the necessity of adopting prompt and effi- 
cient means to promote reaction, Dr. Mas- 
sie observes, " I am not so bigoted, or so 
wedded to any system of medicine, as to be 
its champion to the exclusion of others. I 
consider I have a perfect right to investi- 
gate all of the different systems, and avail 
myself of any information which I may 
deem important and true, and I will pre- 
mise by saying that the treatment I now 



154 ASIATIC CHOLERA. 

adopt for cholera has been attended with 
more success than when I treated it under a 
different system." 

" If I am called at an early period of the 
disease, even when there is nausea, vomit- 
ing, and diarrhoea, I commence the treat- 
ment by giving equal parts of rhubarb root 
pulverized, saleratus, and peppermint plant 
powdered ; one pint of boiling water being 
added to half an ounce of this compound. 
After simmering it for half an hour, sweeten 
with loaf sugar and strain, and, when nearly 
cold, two or three table-spoonsful of good 
French brandy should be added. Give 
two table-spoonsful of this, taken warm, in 
connection with the following preparation, 
viz. : 5. Pulverized cinnamon, cloves, and 
gum guaiacum, each one ounce, good brandy 
one quart, given in two tea-spoonsful to a 
table-spoonful every fifteen or twenty min- 
utes to an adult." 

" The patient should be well covered with 
warm clothing, and bottles of hot water, 
bricks and stones placed around his body. 
This course is almost sure to be followed 



DIFFERENT MODES OF TREATMENT. 155 

by a moderate moisture of the skin, which 
should be kept up for eight or ten hours ; 
to do^ which, I give ptisans of catnip or 
spearmint, and apply hot tincture of Cay- 
enne by flannel cloths over the abdomen ; 
if this fails to keep up the perspiration, I ad- 
minister the following : 5. Camphor, grs. x. ; 
Ipecac, grs. v. ; Opium, grs. ijss • Supercar- 
bonate of soda, Bij. Mix, and divide into 
two, three, or more powders ; give one 
every hour, or oftener." 

" In very urgent cases, I have used tinc- 
ture of camphor, 1 iv ; essence of pepper- 
mint, 1 iv ; syrup of ginger, § ss ; tincture 
of Cayenne, 3 j. A table-spoonful, from one 
to four in an hour. I have given the saturated 
tincture of prickly ash, with the compound 
tincture of guaiacum, with good effect, in 
doses from a tea-spoonful to a table-spoonful 
every fifteen or twenty minutes. When there 
is excessive irritability of the stomach, the 
following injection should be given after 
every discharge : ij . Saturated tincture of 
prickly ash, |ss; water, §j ; tincture 
opii, 3ss. Mix." Such are the views of 
14 



156 ASIATIC CHOLERA. 

Dr. Massie, as presented in Ms Treatise on 
the Eclectic Southern Practice of Medicine. 
They are confirmatory of the observations 
and experience of many other eminent 
practitioners, and strictly accord with his 
views of the pathology and essential phe- 
nomena of the disease. 

We find in a very valuable work, en- 
titled the Eclectic Practice of Medicine, 
published at Cincinnati by Professors 
Powel and Newton, a full account of the 
mode of practice generally adopted and 
pursued by the great body of physicians in 
the West, the substance of which we are 
induced here to present, preserving, as far 
as practicable, the language of the authors. 
For our inquiries are, What are the modes 
of practice? and what modes, if any, are 
consistent with the pathology and the essen- 
tial phenomena of the disease ? Each mode, 
however prominent or however obscure, is 
entitled to a fair representation in our in- 
quiries, and should be held responsible for 
its deviations from the strict and generally 
received principles of science, and the con- 



DIFFERENT MODES OF TREATMENT. 157 

sequences arising from any such deviations, 
or departure therefrom. 

" When called upon," say these eminent 
professors, " to treat a patient in the early 
stage of the disease, he should at once be 
placed in a recumbent position, and every- 
thing should be avoided which will have 
a tendency to disturb the mind, as well as 
the stomach and bowels. In the greater 
part of cases in this early stage, the ad- 
ministration of the compound pills of cam- 
phor, made according to the following 
formula, is sufficient to prevent a further 
development of the disease : 

5. Camphor, } 

Opium, v aa., gr. xxxv. 
Kino, j 

Capsicum, . . . . gr. v. 
Conserve of roses, Q. S. — Mix. 

Divide into thirty pills, and give one 
after each discharge from the bowels, or 
oftener, if the urgency of the case requires 
it. Occasionally, however, there may be 
applied a large sinapism over the whole 



158 ASIATIC CHOLERA. 

abdomen with advantage. Greenhow's aro- 
matized brandy* the aromatic tincture of 
guaiacum* may sometimes be beneficially 
alternated with this pill. Should there be 
an overloaded condition of the alimentary 
canal, the fluid extract of rhubarb and 
potassa * three parts, with saturated tinc- 
ture of prickly-ash berries, one part, may 
be administered in table-spoonful doses 
every hour, and continued until the bowels 
are properly evacuated, after which the 
above astringents may be given ; but where 
the diarrhoea is excessive, it would be im- 
prudent to wait for catharsis, as the dis- 
charge should be checked as speedily as 
possible. 

In the second stage, when nausea, vomit- 
ing, and cramps are present, more active 
means should be pursued. To overcome 
the nausea or vomiting, the preparation of 
Dr. 0. E. Newton, termed in the American 
Dispensatory compound mixture of cam- 
phor,* may be used with excellent effect ; 
it is prepared as follows : 

* See American Dispensatory. 



DIFFERENT MODES OF TREATMENT. 159 

3. Camphor water, "j 

Peppermint water, I aa., f lj. 
Spearmint water, J 
Paregoric, . . . . f 3 ij. 

Mix. 

From a tea-spoonful to a table-spoonful 
may be given every five or ten minutes ; 
and in cases where this does not act suffi- 
ciently prompt, the following may be ad- 
ministered : 

5. Common salt, ... 3j. 
Black pepper, ... 3j. 
Vinegar, . . . . f 3 v. 
Hot water, . . . . f iiv. 

Mix. 

Of this a table-spoonful may be given 
every ten or twenty minutes, and continued 
until the nausea ceases. 

To remove the cramps, hot bricks, or bot- 
tles of hot water, etc., should be kept ap- 
plied to the feet, legs and arms, and cloths 
wet in water as hot as can be borne, must 
be applied over the abdomen and changed 
every few minutes ; this should be perse- 
14* 



160 ASIATIC CHOLERA. 

veringly pursued until relief is obtained. 
Sometimes advantage will ensue from stim- 
ulant applications along the whole length 
of the spine. Cramps of the muscles of the 
limbs may be overcome by bathing with the 
compound cajeput mixture,* either alone 
or in combination with chloroform, and ap- 
plying friction at the same time. This 
course usually checks the further progress 
of the disease, and the patient is saved ; 
however, should it fail and the stage of col- 
lapse come on, in addition to the above 
treatment energetically pursued, the patient 
should be enveloped in blankets, wet with 
water as hot as can be borne, which should 
be renewed every ten or twenty minutes, 
and stimulants may likewise be given ; the 
saturated tincture of prickly-ash berries 
will here be found beneficial, both by mouth 
and enema." 

Dr. Morrow observes, that " to fulfill the 
most prominent indication, the production 
of an equilibrium in the circulation, and 
excitability, the compound tincture of guai- 

* See American Dispensatory. 



DIFFERENT MODES OF TREATMENT. 161 

ac * may be given. This is prepared by- 
adding gum guaiacum, cinnamon and cloves 
— each, one ounce to a quart of best brandy, 
and is administered in tea-spoonful does in 
hot, sweetened water and brandy, every 
fifteen or twenty minutes till relief is ob- 
tained. As a general remedy, its exhibi- 
tion is most salutary. In some cases where 
excessive nausea is the most prominent 
symptom, it may be advisable to administer 
an emetic to relieve the gastric irritability, 
to equalize the circulation and check the 
spasms. For this purpose, the acetous tinc- 
ture of lobelia and sanguinaria* with the 
addition of one-third spirituous tincture of 
aralia spinosa * is preferred. This is given 
in doses from a tea-spoonful to a table- 
spoonful every ten minutes in warm catnip- 
tea, sweetened. In very urgent cases, it 
may be given in larger doses and frequent- 
ly repeated. 

In most cases, the saturated tincture of 

xanthoxylum fraxinifolium bac. may be 

used with great advantage. It is a reliable, 

excellent and prompt remedy. When given 

* See American Dispensatory. 



162 ASIATIC CHOLERA. 

in the early stages, it will frequently re- 
lieve in from ten to twenty minutes. In 
combination with the fluid extract of rhu- 
barb and potassa* it has generally proved 
very prompt and efficient. In cases of par- 
tial collapse, when the patient is suffering 
from severe cramps, Hunn's Antispasmodic 
Mixture * is an excellent remedy. In cases 
of violent spasms, it has been administered 
every ten minutes in doses of from one to 
two tea-spoonsful in hot brandy-and-water 
sweetened, with great advantage, and it is 
peculiarly applicable in such cases where 
there is not too great irritability of the 
stomach. In many cases, camphor is very 
beneficially prepared, by adding one drachm 
of camphorated spirits to a half-pint of 
cold water and the mixture given in tea- 
spoonful doses every three or four minutes. 
Dr. King states that in the early stage 
he has used very extensively the following 
preparation : 

5. Ox Gall, |j. 

* See American Dispensatory. 



DIFFERENT MODES OF TREATMENT. 163 

Capsicum, . . . 



GumGuaiac, . . . [ aa - 31V> 
Leptandrin, . . . 3iv. — Mix. 

This was given in doses of one grain, 
and repeated two or three times a day. 
He had also succeeded in some cases with a 
mixture composed as follows : 
E. Sulphur Sub., . . grs. iv. 
Gum Guaiac, . . grs. ij. 
Charcoal, .... grs. ij. 
Camphor, . . . gr. j. 
Opium, ..... grs. ss. — Mix. 

Dose, one to ten grains, repeated every 
ten minutes until relief is obtained. In 
some cases, however, this compound did not 
appear to exercise any beneficial influence. 
In cases of excessive irritability of the 
stomach, oat-meal cake coffee was given, 
for the purpose of allaying its irritability, 
with admirable effect. The saturated tinc- 
ture of prickly-ash berries,* combined with 
tincture of opium, was used in some cases 
as an injection, with very good effect. 

Dr. R. S. Newton observes that he had 

* Sue American Dispensatory. 



164 ASIATIC CHOLERA. 

also used a preparation composed of equal 
parts tannin, capsicum, camphor and kino, 
with considerable success, to be given 
in doses of four grains, and repeated at 
short intervals until the discharges were 
checked. 

He considered the saturated tincture of 
xanthoxylum fraxinifolium bac* the most 
valuable of all the remedies for the cholera 
which he had tested. When the stomach 
would not retain it, he gave it as an injec- 
tion. It had a peculiar influence on the 
system, and having taken the remedy, he 
could speak from experience of its effects. 
When given as an injection, the effect pro- 
duced was almost instantaneous ; the sensa- 
tion was as if he had received an electric 
shock ; its use was very soon followed by a 
copious perspiration. He had more confi- 
dence in this than any other one remedy 
with which he was acquainted. 

Dr. Wright observes that he had also 
used the neutralizing extract, saturated 
tine, xanthox. fraxi. bac, and the com- 
pound tincture of guaiac* He had succeed- 

* See American Dispensatory. 



DIFFERENT MODES OF TREATMENT. 165 

ed best with a mixture of equal parts tinc- 
ture of prickly-ash berries and neutraliziug 
extract.* 

He had always found it necessary to at- 
tend strictly to the surface. The best ex- 
ternal application he found was equal parts 
of capsicum, salt and mustard. 

Dr. Chase states that, " in the early period 
of the disease, he had used the leptandrin, 
combined with neutralizing extract,* very 
successfully. He thinks opium can be dis- 
pensed with in the treatment of cholera 
altogether. In typhoid cases, he pursued 
an entirely different course, and remarked 
that many cholera cases presented symp- 
toms similar to those described in Wood's 
Practice, as belonging to pernicious fever, 
which must be treated according to their 
peculiar character." 

Such, it is said, is the more general and 
successful practice in the Mississippi Valley, 
where the disease has several times pre- 
vailed in its most malignant form. For its 
curative efficiency much is claimed. Its 
utility, however, must be measured, as in all 

* See American Dispensatory, 



166 ASIATIC CHOLERA. 

other cases, by the unerring rule, the actual 
results sustained by incontrovertible facts, 
The nearer any mode of practice accords 
with the general principle of pathology, the 
greater must necessarily be its success, for 
it is not in this disease, or in any other, that 
the bold, energetic and heroic practice, 
which is inconsistent and incompatible with 
this principle, cures, however extensively 
adopted and rigidly pursued, For this 
principle must direct and govern the prac- 
tice, or else it becomes necessarily experi- 
mental or empirical, and must be inevitably 
attended with the most lamentable results. 

Section IV. — Statistics — Percentage of 
Loss — Variable Results — Their Cause. 

The results of the different modes of 
practice which we have briefly noticed will 
aid materially our effort to discover and 
establish some general principle for the suc- 
cessful treatment and cure of cholera. For 
all modes, whatever be their merits or de- 
merits, are supposed to be founded on the 



STATISTICS. 167 

pathology of the disease. To treat any 
disease successfully, its pathology must be 
observed, and so applied in the arrange- 
ment and adoption of a mode of practice as 
to secure not only entire harmony, but a 
complete and perfect adaptation of the 
treatment to its pathological character. 
The nearer any mode approaches to an ex- 
act conformity to this principle the greater 
will be its success. The neglect to conform, 
in the treatment of the epidemic cholera, to 
this acknowledged and universal law, has, 
no doubt, been the prolific cause of the sac- 
rifice of thousands of valuable lives. For 
this principle is the key to unlock the mys- 
tery of disease, unfold the process of d 3- 
eased action, and ? as an unfailing aid 
definite rule, must govern all correct theo- 
ries as well as all rational practice of 
medicine, under whatever name it may 
be conducted. All practice, then, deviat- 
ing from, opposed, or contrary to, this prin- 
ciple must be purely empirical, and un- 
worthy the confidence of an intelligent 
community. Hence we may refer to statis- 
15 



168 ASIATIC CHOLERA. 

tics rather than argument on the subject, to 
ascertain how far and to what extent each 
of the different modes of practice conform 
to the general principle ; and on the other 
hand, to show what modes may be at fault, 
being deficient in the application of science, 
opposed to the established laws of practice, 
and contrary to observation and experience, 
and therefore utterly and hopelessly em- 
pirical. 

The statistics collected from the most re- 
liable sources, and here presented, may be 
regarded as a fair representation of the 
general average of loss by the different 
modes of practice. In a report now before 
us, it is stated, " The average proportion of 
deaths in Paris from cholera, treated under 
the allopathic practice, was 49 per cent. ; 
while that under the homoeopathic was only 
7£ per cent." " In Vienna, (Aus.,) under the 
former, the deaths are reported at 31 per 
cent. ; while under the latter it was only 8 
per cent. In Bordeaux, death occurred 
under allopathic treatment at the rate of 67 
per cent., and under homoeopathic, 17 per 



STATISTICS. 169 

cent. only. The general average in the 
places last mentioned will stand thus : Al- 
lopathic, 49 per cent. ; homoeopathic, 10J per 
cent." The record of mortality in twenty- 
one hospitals in Europe shows the average 
deaths under allopathic treatment to be 65} 
per cent., while in ten hospitals where the 
cholera patients were under homoeopathic 
treatment, the average deaths from that 
disease was ll£ only* In a report u pub- 
lished by the authorities of Pischnowitz (in 
Prussia), it will be seen that 680 cases were 
treated as follows : 278 treated homoeo- 
pathically, of which 27 died ; 381 treated 
allopathically, of which 102 died." 

In St. Louis, during the prevalence of 
cholera in 1849, the number treated by three 
homoeopathic doctors, to July 13th, was 
1,567, of which 51 died — a loss of 3* per 
cent. 

In Cincinnati, during the month of May, 
there were treated by the eclectic physi- 
cians 330 cases of cholera and 198 cases of 
cholerine, of which only five died. 

In the same city, during the same time, 



170 ASIATIC CHOLEKA. 

there were treated by the allopathic physi- 
cians 432 cases of cholera, of which 116 
died. 

Again, during the month of June there 
were treated by the eclectic physicians, 
when the disease had reached its maximum 
intensity, and many of the patients being 
reached by the physicians only in the col- 
lapsed stage, 764 cases of cholera, with a 
large number of choleroid diseases not fully 
reported. During this month, the mortality 
with all physicians was necessarily greater 
than either in the preceding or subsequent 
month. Including then the month of May, 
the aggregate to July 1st is 1,094 cases, 
with a loss of only 36, which is considerably 
less than four per cent, (being 3.28) ; while 
the mortality of the old school cholera prac- 
tice being 26 per cent, in May, must have 
risen to at least 50 per cent, in June, when 
the ratio of mortality was more than 
doubled with all physicians. The Western 
Lancet for July, 1849, issued while the 
cholera was still raging, and speaking in 
behalf of the allopathic physicians, observes, 



STATISTICS. 171 

" that of the cases of true cholera, with rice- 
water discharges, at least one-half the cases 
in this city, as everywhere else, proved 
fatal. 7 ' This confession of the Lancet, edited 
by a thoroughgoing allopathic physician, 
advocating the interests of that school, must 
be regarded below rather than above the 
actual allopathic loss. Now, admitting the 
Lancet's correctness, and taking into ac- 
count the aggregate loss of only 36 by the 
eclectic physicians in treating 1,094 cases 
of " true cholera," we ask what must have 
been the loss by the allopathic school of 
practice to have brought the average per- 
centage of all schools up to 50 per cent., as 
affirmed by the Western Lancet ? If the 
cholera hospitals be included in exhibiting 
the results of the different modes of practice, 
it will appear from the reports that the 
total number of deaths, compared to the ad- 
missions, was, under the eclectic treatment, 
23 1 per cent. ; under the allopathic treat- 
ment, 60 per cent. This percentage is con- 
fined exclusively to the three cholera hospi- 
tals reported. 
15* 



172 ASIATIC CHOLERA. 

In the report of 1832, by Dr. Atkins, it 
appears " that the total number of cases" of 
cholera in this city, New York, " including 
those in the hospitals, as well as those re- 
ported to the Board of Health, had been 
5,835 on the 1st of September. The total 
number of deaths by cholera to September 
1st was 2,996." More than one-half died. 
" Dr. Buell reports the success," says Pro- 
fessor Clark, " of sixty-grain doses of cal- 
omel in one of the New York hospitals, 
as 93 deaths in 100 cases ;" very remarka- 
ble success ! the largest mortality in the 
city. 

As like causes produce like effects, we 
need not be surprised at this high rate of 
mortality, for, says Professor Aikin, " taking 
the whole number attacked, it is said that 
the number of deaths in Astrakan were as 
one to three ; in that of Mishni Novogorod, 
as one to two ; in Moscow and Kasan, as 
three to five ; and in Penza, in the country 
of the Don Cossacks, as two to three. In 
the summer of 1831 the mortality at Riga, 
St. Petersburg, Mittan, Limburg, and Brody, 



STATISTICS. 173 

according to the Berlin Gazette, was about 
one-half, while at Dantzic, Elbing, and Posen 
it was about two-thirds of the whole num- 
ber attacked. The period of the epidemic, 
however, greatly influenced the mortality ; 
for on the first onset, nine-tenths of all those 
attacked perished, then seven-eighths ; and 
the proportion of deaths forms a gradually 
decreasing series of five-sixths, three-fourths, 
one-half, one-third, till, towards the close, a 
large proportion of those attacked recov- 
ered. The uniformity of this law in every 
country affected with cholera, whether 
Europe, America, India, or China, is ex- 
tremely remarkable. 77 This' high rate of 
mortality is truly and peculiarly illustrative 
of the inadaptation of the general mode of 
the so-called regular practice to the pathol- 
ogy of the disease. This, no doubt, is the 
main cause of its failure, and justly exposes 
it to the unenviable distinction of being 
empirical. 

The practice of Dr. Beach, the physician 
of the Tenth Ward of this city, during the 
prevalence of the cholera in 1832, embraced 



174 ASIATIC CHOLERA. 

about one thousand cases, of which only a 
small percentage was lost. One of his asso- 
ciates, Dr. Hopkins, reported 157 cases, of 
which only 6 died, being less than 4 per 
cent., which probably is not much below the 
general average of the other districts in that 
ward at that time. 

Mr. Forward, an unprofessional gentle- 
man of Kentucky, treated a large number of 
cases, during the prevalence of the disease 
among his employees, numbering over two 
hundred, without the occurrence of a single 
death. Another instance similar in prin- 
ciple is that of Dr. Browne, who reports a 
case treated by rectified oil of turpentine, 
with the most satisfactory and happy result. 
So, too, the late Dr. Sharp, of Paris, Ky., 
adopted a similar principle of practice, and 
became, thereby, eminently distinguished 
for the cure of cholera ; his percentage 
of loss being very small indeed. 

"We might extend these statistics and ref- 
erences, and quote from the reports of 
many other distinguished physicians who 
have been very successful in the treatment 



STATISTICS. 175 

of this disease ; but these are sufficient for 
the purpose of directing our inquiries as to 
the utility and success of different modes 
of practice. It is immensely important to 
ascertain, if practicable, the general prin- 
ciple which has been most successful in the 
treatment of this disease, before it shall 
again make its appearance among us as a 
prevailing and fatal epidemic ; especially 
when we realize and duly appreciate its 
vast mortality, as represented in the report 
now before us, that prior to its recent irrup- 
tion and prevalence in India and Europe, 
nearly fifty millions of the earth's inhab- 
itants have been swept away by this ter- 
rible scourge alone. 

This estimate may, however, appear ex- 
cessive and unworthy belief. Yet the 
general average for the forty-three years 
included is only a little over one million 
per annum, truly a vast number to be car- 
ried off by the prevalence of one disease 
alone. But, if we reduce this estimate 
within more reasonable limits, and take 
only two-fifths of it, or twenty millions, 



176 ASIATIC CnOLERA. 

as an approximation to the truth, it would 
still be appalling, and imperatively demand, 
on account of the vast interests involved, 
the most rigid and thorough investigation 
as to both the direct and indirect cause of 
this vast sacrifice. It will also furnish us a 
sufficient apology for attempting a brief 
review and critical examination of the prin- 
ciples involved in the different modes of 
practice noticed above, in order to ascertain 
any failures or errors that may have, in 
some degree, operated as the indirect cause, 
in procuring this immense loss of life. All 
must admit that there are, in respect to the 
treatment of the cholera, great and pal- 
pable failures and errors which, though they 
have continued for nearly half a century, 
and have been sanctioned by high author- 
ity, as well as by long usage, ought never- 
theless to be fully shown and exposed, so 
that they may henceforth be avoided. In 
our examination, there is but one rule to be 
observed, and one criterion of ultimate 
appeal by which to try each and every 
principle on which any mode of practice 



STATISTICS. 177 

may be conducted. This universal and 
acknowledged rule is Pathology, the science 
which unfolds and exhibits the nature and 
character of disease, and " dictates the 
maxims of rational practice." It is the 
foundation and only base of rational med- 
icine, which proceeds on the assumption 
that the nature and character of disease is 
fully known and appreciated. This knowl- 
edge is not only rational, but indispensable, 
in order to understand and apply the prin- 
ciples which ought to govern in the medica- 
tion and cure of disease. 



CHAPTER IV. 

Section I.— General Principle of Ra- 
tional Practice — Dictated by the Pa- 
thology of the Disease — Confirmed 
by Observation and Experience. 

It lias been observed that the essential 
characteristic, the leading and most prom- 
inent indications requiring special atten- 
tion and permanent relief, are the " Algide," 
or loss of temperature ; the loss of nerve- 
power in the ganglionic and pneumogastric 
nerves and their branches ; the altered or 
disorganized condition of the blood ; the 
impaired or obstructed circulation, and the 
early and direct tendency to congestion ; 
and that these prominent and essential fea- 
tures are correspondingly developed, and in 
their relation to each other are too intimate 
and dependent to admit the idea of priority 

(1*8) 



RATIONAL PRACTICE. 179 

and regular order of succession. The^ 
primary impression being on the blood;, 
these proceeding, pari passu, together con- 
stitute the complex character of the disease; 
and suggest the general principle of ra- 
tional practice. If our pathology be cor- 
rect, it must be regarded as the foundation 
and only base for a successful mode of 
treatment, and must be allowed to dictate 
the maxims of rational practice in the pre- 
vention and cure of this singular disease.-. 
The neglect to apply to the treatment of 
the cholera the science of its peculiar and 
established pathology and phenomena, or 
to give heed to its teachings, has no doubt- 
led to the errors and failures in. practice,-, 
which, from their too general occurrence,, 
induced the learned and celebrated Dr.. 
Velpeau to declare, before the Academy of' 
Medicine in Paris, that "we know nothing- 
more of the treatment of cholera now,, 
than on its first appearance in 1832. All : 
our remedies and modes of practice have- 
failed." 
By observing the fundamental principles 
16 



180 ASIATIC CHOLERA. 

of the science of medicine, and adopting a 
mode of practice suggested by the pathology 
and phenomena of the cholera, these errors 
and failures, which have justly brought 
odium upon the so-called regular profes- 
sion, will probably result in saving nine- 
tenths of those attacked, instead of losing 
that appalling proportion, as has been the 
case in some instances in years past. 

What, then, is the principle which, for near- 
ly half a century, has been strangely over- 
looked, and utterly disregarded by the so- 
called regular profession, so far as the 
maxims of rational practice are concerned 
in the treatment of this disease ? We un- 
hesitatingly affirm the principle suggested 
by the pathology of the disease is, and 
must be, one that will reproduce and re- 
supply the lost caloric, or restore warmth 
to the body ; one that will restore promptly 
the lost nerve-power to the ganglionic 
nerves especially ; one that will arrest and 
remove the tendency to congestion, equalize 
the circulation and relieve the oppressed 
respiration, and thus mitigate the long 



RATIONAL PRACTICE. 181 

train of dependent symptoms. For this 
purpose, a prompt and diffusive stimulant 
is required of sufficient power to meet these 
urgent demands, and suspend promptly any 
further depressing influence or action of 
the cholera poison. A stimulant, essentially 
different from alcohol in any of its forms, 
is required. Alcohol, except so far as it 
necessarily enters into the composition of 
medicines, is inadmissible. So, too, are all 
those stimulants whose action is violent, or 
tends to induce constitutional derangement, 
or impairs in any way the subsequent health 
of the patient. It must be one prompt, 
kind and diffusive in its nature, and pe- 
culiarly adapted to meet and relieve the 
essential urgent symptoms on which the 
whole train of non-essential symptoms de- 
pend. In short, it must be one possessing 
the singular properties of a stimulant, sed- 
ative and astringent, especially an arterial 
stimulant and antispasmodic. 

In confirmation of this doctrine, we may 
refer to the general principle exhibited in 
the most successful modes of practice. Dur- 



182 ASIATIC CHOLERA. 

ing the prevalence of the cholora in 1832, the 
physician having charge of the Tenth Ward 
in this city, in which more than a thousand 
cases occurred, adopted as the principle of 
general practice in that ward a prompt 
and diffusive stimulant, which was, at 
that early day, regarded by him as 
based on the pathology of the disease. 
This principle was strictly observed and 
fully carried out in practice by all his as- 
sistants. The result, embracing the different 
stages of the disease, and some of the most 
malignant cases, was the curing and sav- 
ing of more than nine-tenths of those 
attacked. 

Another instance directly in point is the 
course pursued by Mr. Forward, an unpro- 
fessional gentleman, who had over two hun- 
dred laborers in his employ, among whom 
the cholera prevailed in 1832 with its accus- 
tomed severity. On its first appearance, 
Mr. Forward, unadvised, and depending on 
ordinary domestic remedies, adopted as the 
base of practice in the emergency a prompt 
and diffusive stimulant, which proved per- 



RATIONAL PRACTICE. 183 

fectly successful. Being advised to con- 
tinue the same course, should any more cases 
occur, the result was, in treating a large 
number of cases, including thirteen in his 
own family, that all were cured. Again, 
on the reappearance of the cholera in 1835, 
the same practice was pursued, with the 
same uniform success. Can anything be 
more satisfactory or more conclusive as to 
the adaptation of a principle of practice to 
the pathology of the disease, or furnish bet- 
ter evidence of the correctness of the doc- 
trine we have advanced ? 

Richard Brown, Esq., surgeon, Cobham, 
Surrey, November, 1848, reports a case 
treated successfully by rectified oil of 
turpentine, the therapeutic character of 
which is unquestionable. 

Dr. Massie, of Texas, adopted a similar 
principle of practice, and highly commend- 
ed the same to his professional brethren, as 
the safest, best, and most efficient in the 
treatment of the cholera. He affirms, that 
of all the modes devised for the prevention 
and cure of this disease, none is so simple 
16* 



184 ASIATIC CHOLERA. 

and efficacious as the one exhibited in his 
practice. 

The homoeopathic treatment, which claims 
to be a complete and perfect system, ar- 
ranged and adopted by its originator and 
all his disciples, confirms the correctness of 
the doctrine we have advanced. Its cura- 
tive principle in the treatment of cholera is 
based on a prompt and diffusive stimulant, 
peculiarly adapted, so far as it has any 
power, to meet and relieve the essential 
symptoms of this disease. Hence its suc- 
cess and favorable results, which show a 
saving of nearly nine-tenths of all the cases 
treated. 

Again, the eclectic physicians, who now, 
including all of the reform school, constitute 
a majority of the practitioners of medicine 
in this country, adopted a principle essen- 
tially similar, which has governed their prac- 
tice in the treatment of this disease from its 
first appearance in 1832. Their system 
seems to have been more strictly conformed 
to the pathology of the cholera than that 
of any other school. Hence, their unparal- 



RATIONAL PRACTICE. 185 

leled success furnishes the most substantial 
and conclusive evidence, sustaining the cor- 
rectness of the doctrine we have adduced, 
and the general principle of rational prac- 
tice suggested and imperatively demanded* 
by the pathology of the disease. Their 
treatment, directed mainly to the relief of 
the essential symptoms, has been based on 
a prompt and diffusive stimulant, which, ful- 
filling to some extent the indications requir- 
ed, has enabled them to meet the disease 
on each occasion of its reappearance with 
some assurance of success, and more gener- 
ally to arrest its progress or subdue its 
power as exhibited in its several stages, and 
even in many instances to restore the pa- 
tient and save life in the last stage of the 
almost hopeless collapse. This is clearly 
shown in the actual results which fully ex- 
hibit the incomparable fact that in private 
practice considerably more than nine-tenths 
of the cases of "true cholera " are cured, 
and the constitution and health of their 
patients saved unimpaired. 

Again, this doctrine is substantially con- 



186 ASIATIC CHOLERA. 

firmed by the results of the experiments 
made by Drs. Hill and Davies, in the exhi- 
bition of chloroform, either alone or com- 
bined with other stimulants. In the care- 
fully detailed account of its exhibition in 
the various stages of the disease, it is clear- 
ly shown that its direct action tends to ar- 
rest and suspend the depressing influence 
of the primary cause, and when properly 
combined with other stimulants, affords very 
prompt relief. The favorable results thus 
obtained encourage the hope that it may 
prove a successful remedy and lead to the 
adoption of a more consistent mode of prac- 
tice in the treatment of epidemic cholera. 
In India, in Europe, and in America, it is 
now regarded as a very important remedy, 
and especially indicated in this disease. 
As an antidote to miasmatic poison, and as 
a prompt and diffusive stimulant when 
properly combined, it is admirably calcula- 
ted to meet and suspend the most urgent 
symptoms. In short, it may be considered, 
in relation to this disease, an excellent 
therapeutic agent, and well calculated to 



RATIONAL PRACTICE. 187 

form the base of the principle for which we 
contend. 

But again, our doctrine is confirmed by 
the experiment usually termed "-venous 
transfusion." The solution of soda, when 
raised to a temperature from 105° to 120° 
Fahr., and injected into the veins of the 
suffering patient, gave temporarily prompt 
and immediate relief; bijt, when injected at 
a lower temperature, failed. In this experi- 
ment, the sole and only agent contributing 
to the result was, as before explained, the 
free caloric which immediately permeated 
every tissue, supplied warmth to the body, 
relieved the depressed nerve-power, equal- 
ized the circulation, and restored generally 
the normal action of the system. Of this 
result, and of the diffusive and prompt 
stimulating power of free caloric, there can 
be no question. The principle here evolv- 
ed, which answered so perfectly the impe- 
rious demand and so immediately suspended 
the power of the disease, is the very princi- 
ple dictated by its pathology. Stronger 
and better evidence of the utility of a 



188 ASIATIC CHOLERA. 

prompt and diffusive stimulant, permanent 
in its character and influence, cannot be fur- 
nished ; one that will act kindly, without 
violence and without any disturbance to 
any organ or tissue, to injure or delay the 
return of immediate and perfect health after 
the disease is subdued. Such we affirm to 
be the principle demanded in the successful 
treatment of the epidemic cholera. 

Section II. — Remedies, Recipes, etc. 

Considering the general principle of 
treatment, and the nature of the remedy so 
clearly suggested by the pathology of the 
disease to be fully established, it now re- 
mains for us to point out some of those cur- 
ative agents which may be employed to ad- 
vantage. It may be here observed, that 
among the few that can be confidently rec- 
ommended, there is no single remedy yet 
discovered which seems to possess all the 
properties necessary to meet the complex 
condition presented in a malignant case of 
cholera. Yet it is believed we have simple 



BEMEDIES, RECIPES, ETC. 189 

remedies, which, when properly combined, 
will prove successful. Among the number 
that seem best adapted to meet and fulfill 
the indications, may be named chloroform, 
as the leading remedy on which we may 
reasonably hope for success. This may be 
united with spirits of camphor, the tincture of 
xanthoxyli fraxinifolii bacca, the compound 
fluid extract of rhubarb and potassa* and 
the oil of monarda punctata, and a very 
valuable and reliable remedy obtained. 
The following formula exhibits the mode 
of combination, which may be varied and 
adapted to suit any emergency : 

]j Chloroform, (sq.,) . . . . 3 ij. 

Spirits Camph., .... 3J. 

01. Monarda, gtts. x. 

M. et adde— 

Tine. Xanthox. Frax. Bac, § ij. 

Fluid Ext. Rhei et Potas., § iv. 

M. S. — From 3J. to §ss. every half-hour, 
hour or two hours, according to the urgency 
of the symptoms and the stage of the dis- 
ease. As soon as relief is obtained, it 

* See American Dispensatory. 



190 ASIATIC CHOLERA. 

should be given in minimum doses and less 
frequently. This is admirably adapted to 
•the cold stage, and will give prompt relief 
in a great majority of cases. 

In the premonitory stage, it can be admin- 
istered to good advantage in small and less 
frequent doses. In some instances, an ad- 
ditional astringent may be necessary. The 
deceptive and painless diarrhoea should 
receive prompt attention, and be regarded 
and treated as the incipient form of the 
disease. According to the best authorities, 
the diarrhoea commences with the first 
chemical change or alteration of the blood, 
and proceeds gradually, in most cases, for 
some hours, and even in some instances, 
though rarely, for days. It is not sufficient 
to check the diarrhoea merely ; the cause 
must be removed, which is essentially of 
miasmatic origin. When the cholera is 
prevailing, and the diarrhoea is essentially 
choleraic, or the result of a depressing mias- 
matic influence, it should be treated with 
chloroform, aided, if required, by appropri- 
ate astringents. 



REMEDIES, RECIPES, ETC. 191 

In the fully developed stage, and even in 
the stage of collapse, perhaps no combina- 
tion is better adapted to meet promptly all 
the necessities and wants of the system, and 
suspend the action of the cholera-poison, 
than the one named above. It is a simple, 
prompt and diffusive stimulant, approximat- 
ing the principle indicated. This peculiar 
remedy is essentially required, and should 
be continued through all the stages of the 
disease till relief be obtained, varying its 
administration according to the urgency 
of the symptoms. When the stomach is too 
irritable to retain medicine, it should be 
given by the bowel. Take of the above 
mixture, one-half ounce, of the tincture of 
prickly-ash berries one-half ounce, of the 
tincture of opium ten drops, of warm water 
one ounce and a half — mix and inject. 
This may be repeated after every evacua- 
tion three or four times, unless relief be 
obtained earlier. Thus, it should be ad- 
ministered perseveringly by stomach and 
by bowel, aided by due employment of 
all necessary external means for furnishing 
17 



192 ASIATIC CHOLERA. 

warmth and giving relief. Opium, how- 
ever, should be omitted after two or three 
injections. Its continued use to check the 
movement of the bowels is decidedly inju- 
rious. 

The vomiting and irritability of the 
stomach may often be allayed by a strong 
decoction of spearmint and horse-pepper- 
mint (monarda punctata), equal parts, alter- 
nated with camphor water in small repeated 
doses every five minutes. This will often 
succeed when all other means fail. 

The compound cajeput mixture* is a very 
excellent and prompt stimulant, and maybe 
alternated with other remedies with good 
effect. It is particularly useful in allaying 
violent cramps, and restoring warmth to the 
body, and may be given in doses of one tea- 
spoonful every ten or twenty minutes in 
mucilage, simple syrup, or, better still, in 
hot brandy-and-water sweetened. 

The aromatic tincture of guaiac* will be 
found very useful in some cases, and may 
be united with chloroform according to the 
following : 

* See American Dispensatory. 



REMEDIES, RECIPES, ETC. 193 

3. Chloroform, (sq.) . . 3 ij. 

Spirits Camphor, . . 3J. 

01. Monarda, . . . gts. v. 

M. et adde — 

Tine. Guaiac. Arom., siv. 

M. 
S. — From one-half to one tea-spoonful 
every half hour, or, if necessary, in violent 
cases every twenty minutes, in a little 
sweetened water. This may be alternated 
with some other remedy to great advan- 
tage. 

Chloric ether has been with some a very 
favorite remedy, and, in combination with 
other diffusive stimulants, may serve a good 
purpose. So, too, the spirits of turpentine, 
and the rectified oil of turpentine, have 
proved very beneficial, the former in com- 
bination, the latter administered alone. 
These agents, however, can be rendered 
more prompt and effective by combination. 
It is the promptness, the instantaneous or 
electric action like that of oxygen, ozone, 
and caloric that gives value to the combi- 
nation, and renders it peculiarly efficacious 



194. ASIATIC CHOLERA. 

when it possesses the other peculiar proper- 
ties required. 

In the early stage, sulphuric acid, in the 
form of elixir vitriol, has given very prompt 
relief, and is very highly recommended as a 
curative agent in the treatment of this 
disease. The following formula presents 
the mode of its exhibition : 

5. Elixir Vitriol, .... fj. 
Tine. Xanthox. Frax. Bac. § ij. 
Ess. Lemon, .... 3J. 

M. — S. — Tea-spoonful in a gill of sweet- 
ened cold water every two or three hours. 

This recipe was used in the incipient stage 
quite extensively in the epidemic of 1849, 
with decided advantage. It generally re- 
moved the symptoms speedily, without any 
other treatment. In the more advanced 
stage it was thought not so reliable as other 
means named above. 

Dr. Fuller, of this city, advocates the use 
of sulphuric acid as a prompt and efficient 
remedy, and affirms that according to his 
experience, a great majority of cases may 
be cured by this mode of treatment. 



REMEDIES, RECIPES, ETC. 195 

Dr. Cox, of England, has also spoken in 
its favor, and recommended its use as an in- 
fallible remedy. The eclectic physicians 
are entitled to the credit of its first intro- 
duction as a curative agent in the treatment 
of the Asiatic cholera, combined with the 
tincture of prickly-ash berries and the es- 
sence of lemon, as noticed above. In our 
estimation it may be rendered more effec- 
tive, combined according to the following : 
$. Elixir Vitriol, V __ 

Chloric Ether, j ' ' aa *' *J- 

Tine. Xanthox. Frax. Bac. § ij. 

Ess. Lemon, 3j\ 

M. 
S. — A tea-spoonful in a gill of sweet- 
ened cold water every two or three hours. 
Thus combined, it forms a very prompt and 
diffusive stimulant, and is well adapted to 
meet the indications in the earlier stage of 
the disease. In the last stage perhaps no 
remedy will be found so prompt and decid- 
ed in its action as the injection named above, 
with the internal use of chloroform as com- 
bined in the recipe on page 189. 
17* 



196 ASIATIC CHOLERA. 

In cases of excessive irritability of the 
stomach, the following combination was ad- 
ministered with good effect, and was espe- 
cially beneficial in cases attended with 
stupor from the commencement of the 
disease : 



5. 



Common Salt, . . 


• • 3J. 


Black Pepper, 


• • • 3j. 


Vinegar, . . . , 


, . f. 3V. 


Hot Water, . . 


f. 1 iv, 


M. 





Of this, when settled, or strained, a 
table-spoonful may be given every ten or 
twenty minutes. It seldom failed to quiet 
the stomach and check the motion of the 
bowels. In this condition the injection 
should be also administered, and repeated 
as occasion may require. 

Some advocate the use of the spirits of 
ammonia and tincture of capsicum, properly 
combined with other diffusive stimulants, as 
a very efficient and successful remedy. The 
following is, perhaps, the most desirable 
formula : 



REMEDIES, RECIPES, ETC. 197 



* aa., 3 iij. 



5. Chloroform, (sq.) 
Spts. Camph., 
Spts. Ammonia Aromat., 
Tine. Capsicum, 
Elix. Opii (McMunns), . . 3 ss. 
Syr. Zingiberis, 1 ij. 

M. — S. — Tea-spoonful in water every 
thirty minutes till relieved. Then less fre- 
quently, according to circumstances. This is 
said to give very prompt relief in the earlier 
stage of the disease. With some practi- 
tioners the following has been quite a favor- 
ite remedy : 

3. iEther Chloric, . . . - fj. 

Tine. Cardamom., ... 3 ij. 

Spts. Camph., .... f ss. 

Elix. Opii (McMunn's), . 3 ss. 

Syr. Zingib., . . . , I ij. 
M. 

S. — Two tea-spoonsful in water every 
10 or 30 minutes till relieved, then con- 
tinued less frequently and in less doses 
every one, two, three, or four hours, accord- 
ing to circumstances. 



198 ASIATIC CHOLEBA. 

For the purpose of promoting reaction in 
cholera and diarrhoea, the following formu- 
la has been extensively used and most uni- 
versally approved. It is, indeed, so highly 
valued in England and in India, that it is 
ordered to be always in store and in readi- 
ness in the Medical Field Companion of the 
army when on the march : 

g. 01. Anisi, J 

OK Cajeput, > . . . aa., 3 ss. 

01. Juniper, ) 

iEther Chloric, .... i ss. 

Liquor Acid. Haleri * . . 3 ss. 

Tine. Cinnamon, ... 1 ij. 

M. 

S. — Ten drops every fifteen minutes, in a 
table-spoonful of water. An opiate may 
be given with the first and second dose, 
but should not be continued. 

Another recipe which has been used with 
some success in private practice, illustrative 
of the use of chloroform as a diffusive stimu- 
lant and sedative, is the following : 

* Sulphuric acid, one part; rectified spirit, three parts. 



REMEDIES, RECIPES, ETC. 199 

$. Chloroform (sq.) 

Spts. Camph., 

Tine. Capsicum, . aa., 3 ij- 

Tine. Zingib., 

Tine. Car damom., 

Syr. Simplex, .... § ij. 

M. 
S. Tea-spoonful in a little water every 
half hour, hour, or two hours, according to 
circumstances. An opiate may be given 
with the first and second dose, but should 
not be continued. Should the first dose be 
ejected, give another immediately after the 
vomiting. 

In collapse, which is simply a more ad- 
vanced stage of the disease, indicating the 
gradual failing of all the powers of life, our 
main reliance is on enemata, as noticed 
above, often repeated, and continued as oc- 
casion may require. 

Rev. Dr. Hamlin, of Constantinople, ob- 
serves, " It is difficult to say when a cure 
has become hopeless. The blue color, the 
cold extremities, the deeply sunken eye, the 
vanishing pulse, are no signs that the case 



200 ASIATIC CHOLERA. 

is hopeless. Scores of such cases in the 
recent epidemic have recovered." 

Here it may be proper to add, that a cure, 
even with the most efficient remedies, cannot 
be easily effected without placing the pa- 
tient at the commencement in a recumbent 
position. This appears indispensable. The 
patient should be placed in bed and kept 
there in the horizontal position, comfortably 
covered with blankets, and with warm ap- 
plications to the feet. Every necessary 
convenience should be at once provided to 
prevent, if possible, the patient from rising 
to, or standing upon, his feet, for the erect 
posture, before relief is fully obtained, will 
inevitably hasten the unfavorable termina- 
tion of the disease. On this direction, 
therefore, the physician must insist if he 
would save his patient. Says an eminent 
physician, perfectly familiar with the dis- 
ease, " This direction faithfully observed, 
and good nursing, will save very many pa- 
tients even without medicine." 

Of the auxiliary aids, consisting of vari- 
ous external applications, we cannot speak 



REMEDIES, RECIPES, ETC. 201 

in very flattering terms. To the mind of 
the practitioner the more important are 
readily suggested, and are promptly em- 
ployed by nurses in the earlier stages of the 
disease. It is impossible for any person to 
attend on a case of true cholera without 
being instinctively moved to apply heat 
friction, and warm stimulants to the surface 
for the relief of the suffering patient. Any 
attempt to prevent these kind offices and 
apparently beneficial appliances would be 
unwise, and most certainly, in private prac- 
tice, unavailing. It becomes, therefore, ne- 
cessary to direct the use of those which are 
most agreeable to the patient and tend to 
preserve and sustain the recuperative power; 
those which tend to weaken and depress the 
system are the most objectionable. Among 
the number that seem to do good, we may 
mention bottles of hot water to the feet and 
calves of the legs, hot bricks dipped in 
water and wrapped in flannel and applied 
to different parts of the body ; blankets wet 
in water as hot as can be borne, and wrung 
out so as not to drip, and applied to the 



202 ASIATIC CHOLERA. 

whole surface, and changed at short inter- 
vals, so as to keep up a steady and perma- 
nent temperature of the surface ; flannels 
moistened with spirits of turpentine, or 
other stimulant embrocation, and laid over 
the stomach and bowels, may be employed, 
as these all, in some instances, seemed to be 
beneficial. Their necessity and use, however, 
must be governed by circumstances. As 
we have before said, our main reliance is 
on a prompt and diffusive stimulant inter- 
nally ; other means, at best, are very uncer- 
tain. 

Such are some of the remedies evidently 
suggested by the pathology and phenomena 
of the disease, and adapted to meet and re- 
move the more urgent, essential symptoms. 
They are not entirely new. They have been 
employed to some extent in former epidem- 
ics of cholera, and have sustained a good 
reputation as useful and curative agents in 
the treatment of this disease. The combi- 
nations here suggested are the result of ob- 
servation and experience, and are intended 
to present the form in which these remedies 



PROPHYLAXIS. 203 

can be exhibited to the best advantage. 
They are simple, prompt, and reliable, such 
as will leave the system, when the disease 
is subdued, in its ordinary condition, with- 
out any injury whatever to prevent its im- 
mediate return to its normal state of health. 
Let them be employed, and their utility 
thoroughly tested. They will bear the 
strictest scrutiny, and sustain their reputa- 
tion untarnished under the most trying cir- 
cumstances. Should the cholera appear 
again in our midst in its epidemic form, and 
these remedies be generally employed and 
properly administered, we venture to pre- 
dict their effi'cacy will be abundantly proved 
in the successful result of saving more than 
nine-tenths of those attacked. 

Section III. — Prophylaxis — or Means of 
Prevention. 

In presenting a course of preventive 

treatment consistent with the origin and 

general character of the disease, we are 

necessarily limited to the means of sustain- 

18 



204 ASIATIC CHOLERA, 

ing the normal action of the system, and 
suppressing the operation of those causes 
which, by reducing the general health, tend 
to generate, foster., and develop the cholera. 
Of the former so much has been written 
and published, inculcating the general prin- 
ciples of hygiene, that it seems quite un- 
necessary to dwell on a subject so familiar 
to the great mass of community ; yet, there 
arc occasions when the most familiar truths 
have to be impressed upon the mind, by 
constant repetition., to prevent threatened 
dangers, and obviate the most serious con- 
sequences. In no instance is this more im- 
portant than in time of prevailing ep- 
idemics ; for it is an undeniable fact, that 
multitudes will neglect the most obvious 
principles of hygiene, and tolerate, with 
utter indifference, the most offensive nui- 
sance, in and around their dwellings, and 
if attacked by disease, will often wonder 
why they, more than others, should be visited 
by a malignant disease, or become the vic- 
tims of a prevailing epidemic. Hence the 
necessity of urging the observance of some 



PROPHYLAXIS. 205 

of the most obvious principles of hygiene, 
in the preventive treatment of Asiatic 
cholera. 

Pure air, pure water, and a frugal nutri- 
tious diet are Nature's great preventives for 
the thousand ills of life. These are the 
great essentials in sustaining the healthful 
and normal condition of the system, always 
of primary importance in preserving its 
tone and energy, and rendering it im- 
pervious to any miasmatic or epidemic 
influences. Therefore, the tone of the sys- 
tem should, more especially when epidemics 
are prevailing, be kept fully up to its nor- 
mal standard. This cannot be accomplished 
without pure air, — whether our dwellings 
be located in the city . or in the country ; 
free ventilation of all apartments is of the 
first importance. Kitchens, sitting-rooms, 
dressing-rooms, and especially sleeping- 
rooms, should be kept constantly and 
thoroughly ventilated j cellars and vaults, 
too, should receive attention, and be kept 
free jrom a deteriorated or foul atmos- 
phere. Everything within and without 
18* 



206 ASIATIC CHOLERA. 

our dwellings, tending to impregnate the 
atmosphere with noxious effluvia, should be 
removed, and the foul air promptly purified 
by the use of appropriate disinfectants. 

Pure water for drinking and culinary 
purposes is another preventive remedy, 
whose employment cannot be safely omitted. 
It is a well-known fact that, in various lo- 
calities, wells only a few feet deep, which 
are mainly supplied by drainage or sur- 
face water, have proved a fruitful source* 
and in some instances a direct and efficient 
cause of epidemic cholera. 

The water from rivers flowing past large 
cities and villages is often so impure as to 
render its use decidedly deleterious, if not 
an actual source of disease. In some cases 
they have been literally so filled with por- 
tions of fish, and other animal matter, 
that all city supplies were made endurable 
only by long-continued filtration. The 
waters of many of our Southern and West- 
ern rivers are rendered impure from the 
lime and surface drainage with which 
they are so highly impregnated that they 



PROPHYLAXIS. 207 

often become a direct source of diarrhoea 
and cholera. Pure water, free from the 
impregnation of vegetable, animal and 
mineral substances, should be sought and 
obtained for domestic use. 

A good nutritious diet is an indispensable 
requisite in the prevention of disease. The 
system in comparative health requires, and 
should regularly receive, its proper aliment. 
Its daily recurring demands should be judi- 
ciously met with pure and wholesome food, 
in such quantity as can be readily digested, 
assimilated and duly appropriated for the 
supply of its wants. Due regard, however, 
must be had to the existing and peculiar 
condition of the digestive organs, on which 
mainly depends the process of supporting 
and perpetuating the general health. * 

It is not the profuse variety and the in- 
congruous mass composed of baked, roasted, 
boiled and fried meats, fish and fowl, oyster, 
lobster, frog and turtle, with puddings, tarts, 
jellies, cakes and creams from the pastry 
room — fruits and salads, native and foreign, 
rich and rare— alcoholic stimulants, and cool- 



208 ASIATIC CHOLERA. 

ing ices, but the simple, plain and frugal diet, 
properly cooked and particularly nutritious, 
that conduces to the most vigorous health. 

Regular, temperate habits in all things, 
are especially commended ; excesses of all 
kinds are reprehensible. Great and sudden 
changes in the habits of living are always 
deleterious, and must be particularly so, 
when an appalling and fatal epidemic is 
prevailing. Temperance, sobriety and 
cheerfulness, regular hours for meals, for 
rest and for business, repeated ablutions 
and perfect cleanliness, moderate exercise 
and avoidance of irregularities, persevering 
self-government and duly subjected passions, 
all contribute to health, to happiness, and 
the prevention of disease. 

Exposure to the extremes of heat and 
cold should be avoided, and the clothing 
properly adapted to the climate — to the 
season and its variable temperature. Con- 
stant vigilance is necessary to guard against 
the numberless causes tending to produce 
an • abnormal condition, resulting in the de- 
rangement of the stomach and bowels, or 



PROPHYLAXIS. 209 

in depressing the nervous power, thus en- 
feebling and prostrating the general health. 
The neglect of these hygienic principles 
and essential preventives of cholera may 
induce the condition which temptingly in- 
vites the disease. Some are vastly more 
susceptible than others, and may not be 
able, with all their watchfulness and care, 
to avoid an attack, should the disease ex- 
tensively prevail among us. 

The premonitory symptoms requiring 
special attention, when the epidemic chol- 
era is prevailing, are definitely presented 
in Chap. II., Sec. 2, page 56, to which 
special reference is made. Whenever any 
of these do occur, though generally sup- 
posed to present no particular characteris- 
tic of the cholera, they should, however, 
receive prompt attention. The loss of ani- 
mation, the depression of nerve-power, the 
pain in the forehead and slight vertigo, the 
nervous agitation and oppression at the 
chest, with slight nausea, may in most in- 
stances be promptly removed. They should 
be at once patiently and perseveringly 



210 ASIATIC CHOLERA. 

treated by the use of camphor water, pre- 
pared as follows : Take spirits of camphor, 
one tea-spoonful, and put it into a half-pint 
of cold water, and give of the mixture two 
tea-spoonfuls every half-hour, hour, or two 
hours, according to the severity of the 
symptoms. A strong decoction, or tea of 
horsemint (monarda punctata), is an excel- 
lent remedy even in this early stage. The 
essence of monarda, or horsemint, in doses 
of eight or ten drops in a little water, and 
repeated every hour or two, will often give 
prompt relief. Where the horsemint can- 
not be obtained, the spearmint, and the pep- 
permint also, may prove serviceable. * 

Keith's concentrated Tincture of Vera- 
trum Viride is also an excellent remedy in 
these premonitory symptoms. Put three or 
four drops into a tumblerful of cold water, 
and give of the mixture a tea -spoonful 
every hour or two hours, as occasion may 
require. This may be alternated with the 
essence, or tea of horsemint. 

But another more general symptom, 
which may be properly termed the incipient 



PROPHYLAXIS. 211 

stage of the disease, is the slight diarrhoea, 
usually termed painless, though it is by no 
means always so, but frequently the very 
reverse, severe and painful. This at first 
may be slight, but gradually increasing, 
soon becomes obstinate, painful, and exceed- 
ingly difficult to control. It therefore 
should receive attention at its very com- 
mencement, for it is in reality the stealthy 
invasion of the citadel — it is the cholera. 
The loss of life becomes imminent ; treat- 
ment becomes indispensable ; send at once 
for your physician. And, in the meantime, 
continue the camphor mixture, the horse- 
mint tea, and give of the fluid extract of 
rhubarb and potassa, prepared according 
to the formula in the American Dispensa- 
tory, one or two tea-spoonfuls every hour, 
and, if necessary, add four or five drops of 
laudanum, or its equivalent in paregoric, to 
each dose, till relieved. In this early stage, 
opium in small doses may be given^four or 
five times, but should not be continued. 
These remedies, properly administered, will 
control the great majority of cases. 



212 ASIATIC CHOLERA. 

If, however, the diarrhoea be uncontrol- 
led and vomiting ensue, the recipe on page 
189 will be found very efficient, and should 
be perseveringly administered till relief is 
obtained. It is prepared as follows : Chlo- 
roform, two drachms ; spirits of camphor, 
one drachm ; essence of monarda (or horse- 
mint) , three drachms ; tincture of prickly-ash 
berries, two ounces ; fluid extract of rhubarb 
and potassa, four ounces — mix. Give from 
one-half to one table-spoonful every half- 
hour, hour, or two hours, according to the ur- 
gency of the symptoms and the stage of the 
disease. This remedy is well adapted to 
every stage, and may be used in collapse as 
an injection, combined as follows : Take of 
the above mixture two table-spoonfuls, and 
add to it tincture of prickly-ash berries, two 
table-spoonfuls; laudanum ten drops; warm 
water, six table-spoonfuls — mix, and inject 
up the bowel. This injection should be re- 
peated as often as required. In some des- 
perate cases it has been repeated many 
times and the patients saved. 

Wherever the disease prevails, all dis- 



FORMULA. 213 

charges from cholera patients should be 
promptly disinfected and disposed of. Bed- 
ding, linen, water-closets, cesspools, etc., 
should be thoroughly disinfected and reno- 
vated, so that no germ may remain to prop- 
agate the disease. 



FORMULAE 

for some of the preparations used in the 
above recipes. 

G-reenhow's Aromatic Tincture of Guaiacum. 
— Take of guaiacum, cloves and cinnamon, each., in 
powder, one ounce ; best brandy, two pints. Mace- 
rate for fourteen days and filter. 

Dose.— From a tea-spoonful to a table-spoonful, in 
sweetened water, every fifteen or twenty minutes. 
— Am. Bis. 

Compound Cajeput Mixture— Hunn's Drops. 
— Take of oils of cajeput, clovesj peppermint, and 
anise, each, one fluid ounce; rectified alcohol, four 
ounces. Dissolve the oils in the alcohol. 

The ordinary dose is from ten drops to half a tea- 
spoonful ; to be given in simple syrup, mucilage of 
slippery-elm, or in hot brandy and water sweetened, 
— Am. Bis, 



214 FORMULA. 

Fluid Extract of Rhubarb and Potassa. — 
Take of the root of the best India rhubarb, in powder, 
and bicarbonate of potassa, of each, one ounce ; cas- 
sia or cinnamon, and golden seal, in powder, of each, 
half an ounce ; boiling water, one-half pint. Mace- 
rate the roots and seeds for an hour ; strain and dis- 
solve the potassa in the strained liquor when nearly 
cold, and add one gill best brandy ; essence of pepper- 
mint, one tea-spoonful, and refined sugar, two ounces. 

Dose. — From one to two tea-spoonfuls as often as 
necessary. — Am. JDis. 

Tinc. Xanthoxyli, or Tincture of Prickly-ash 
Berries. — Take of prickly-ash berries eight ounces ; 
diluted alcohol, two pints. Form into a tincture by 
maceration, or displacement, and make two pints of 
tincture. 

The ordinary dose is twenty or thirty drops. In 
cholera, from a tea-spoonful to one or two table-spoon- 
fuls, according to circumstances. — Am. Dis. 

Tincture of Oil of Monarda — Essence of Mo- 
narda, or Horsemint. — Take of oil of horsemint one 
fluid ounce ; alcohol, nine fluid ounces, Imp. Meas. 
Mix with agitation. 

Dose. — From ten to twenty drops on sugar, or in 
sweetened water. — Am. Dis. 

Elixir of Opium, prepared on the base of Du- 
puy's formula is less objectionable as an ingredient 
in recipes for an advanced stage of cholera than 
other preparations of that drug. 



